15576 (RPL)•414
Qub&
P.O. BOX 1504 No. 15576
Building 78-495 CALLE TAMPICO
Address 0--82ft Necta n LA QUINTA, CALIFORNIA 92253
Owner
Clinton Cogbill
BUILDING: TYPE CONST. OCC: GRP.
Mailing
Address Sc'u'rf, as above A.P. Number
City Zip Tel.
La gainta 92253 Legal Description
Contractor. Project Description Pc]:i1 Intl ',;»a
4.1-910 BQ1,4 *ailk
City Zip Tel.:
Pain Desert 92260 I
State Lic. City
& Classif. 5551711 Lic. #
'Arch:, Engr.,
Designer
Address Tel.
City (Zip ( State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that l am licensed,tinder provisions of Chapter 9 (commencing with Section
7000) of Division.{3 ;of they Busindss`and•Professions Code, and my license is in full force and
V.}�Ct. - �.y t. `iF, i.✓V f , tr( f'r,/.:���� i
SIGNATURE r- DATE
OWNER -BUILDER DECLARATION :` q
I hereby affirm that I am exempt from, the Contractors' License Law for the following
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a
permit to construct, atter, improve, demolish, or. repair any structure, prior to its issuance also
requires the applicant for such permit to file a signed statement that he is licensed pursuant to
the provisions of the Contractor's License Law, Chapter 9 (commencing, with Section 7000) of
Division 3 of the Business and Professions Code, or that. he is exempt therefrom,. and the basis
for the alleged exemption. Any violation of Section 7031.5 by 'any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars ($500).
❑ I, as owner of the property, or my employees with wages as their sole compensation, will
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and
Professions Code: The Contractor's License Law does not apply to an owner of property who
(wilds or improves thereon and who does such work himself or through his own employees,
provided that such improvements are not intended or offered for sale. If, however, the building
or improvement is sold within one year of completion, the owner -builder will have the burden
of proving that he did not build or improve for the purpose of sale.)
O 1, as owner of the property, am exclusively contracting with licensed contractors to con-
struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law
does not apply to an owner of property who builds or Improves thereon, and who contracts for
such projects with a contractors) #sensed pursuant to the Contractor's License Law.)
f
❑ 1 am exempt under Sec. B. & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self -insure, or a certificate of
Woiz=�70
or a certified copy thereof. (Sec. 3800, Labor Code.)
Polpany
Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
•WORKERS'COMPENSATIONINSURANCE
(This section need 'not be completed if the permit is for one hundred dollars ($100) valuation
or less.)
I certify that in the performance of the work for which this permit is issued, I shall not
employ any person in any manner so as to become subject to the Workers' Compensation
Laws of California
Date Owner
NOTICE TO APPLICANT: ff, after making this Certificate of Exemption you should become
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked. '
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND
SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE
HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION,
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE' LABOR CODE, INTEREST, AND
ATTORNEY'S FEES.
This Is a building"permit when properly filled out, signed and validated, and is subject to
expiration it work thereunder is suspended for 180 days.
1 certify that I Have read this application and state that the above information is correct.
I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives -of this city to enter the above-.
mentioned property for inspection purposes.
Signature of applicant Date
Mailing Address
City, State, Zip
REMARKS
ZONE:
BY:
Minimum Setback
Distances:
Sq. Ft.
Size
No. No. Dw.
Stoties Units
New Add ❑
Alter ❑ Repair ❑ Demolition
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE
XJNSPECTOR
Issued by:
Date r—Permit
Validated by:
Estimated Valuation
$10,000.00
PERMIT
AMOUNT
Plan Chk. Dep. %
Plan Chk. Bal.
76 . 0 5
Const.
117.00
Mech.
24.00 -
Electrical
45.00
Plumbing
27.00
-S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTALg'3�
.5
REMARKS
ZONE:
BY:
Minimum Setback
Distances:
Front Setback frorr Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE
XJNSPECTOR
Issued by:
Date r—Permit
Validated by:
I II )I
Validation:
By f Vr,
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING. FEES
IST FL. SQ. FT. ® $
2ND FL. SO. FT. ®
POR. SQ. FT. ®
GAR. SO. FT. ®
CAR P. SQ. FT.
WALL SQ. FT. ®
SQ. FT. ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
ROUGH PLUMB.
FLOOR DRAIN
MECHANICAL FEES
HEATING (ROUGH)
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
DUCT WORK
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
GAS (ROUGH)
LAUNDRYTRAY
AIR HANDLING UNIT CFM
HEATING (FINAL)
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET'
COMPRESSOR HP
POLE, TEM/PERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SQ. FT. ® c
BATH TUB
BOND BEAM
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL '
LUMBER GR.
SQ.FT.GAR p 3/ic
HOUSE SEWER
FINAL INSP.
ROOFING
/
�r�i G— U c
GAS PIPING
PERMIT FEE
REMARKS:
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE LPL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
GROUND PLUMBIN
UNDERGROUN
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP -
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
GAS (FINAL) s
l
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
$
GRADING
cu. yd.
plus x$
_$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
/
�r�i G— U c
�t 7. C-7 S� .
REMARKS:
VENTILATION
FIRE ZONE ROOFING '
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
AL INSPECTION`- ( S
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESHNITIALS
GARDEN WALL FINAL