14584 (BLCK)t
' P.O. BOX 1504
No.14584
Building 78-495 CALLE TAMPICO
Address 50-970 Nectareo LA QUINTA, CALIFORNIA 92253
Owner
P ame
Mailing BUILDING: TYPE CONST. OCC. GRP.
Address
_ A.R. Number
City Zip Tel.
La Quinta 92253 345-7755• Legal Description
ContractorProject Description Z201f of 6a Garden Block Wall
R2tnchca Capistrano Develop; nt
Addressfor' SFD currently under construction
- .
P.A.Hox 980
City Zip Tel.: "
lal Quinta 92253 345-7755
State Lic. City
& Classif. 597975 LiC. # 1969 Sq. Ft. No. No. Dw.
Arch., Engr., .
Size • Stories Units
Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address Tel.
CityZip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I herebyaffirm that•I' a t licensed under provisions of Chapter 9 commencin
p ( g ullf Section
7000) of ivisiori`3 of the Bueiness•and Professions Code, and my license'is in full force and '
effect:
SIGNATURE/ 1 A ordo, 1 /.,i,p,r"%c, DATE
OWNER•BUILDERrbECL9RAT10N
1 hereby affirm that 1 am exempt from the Contractors License Law for the following Estimated Valuation �n y �pA nh
reason: (Sec. 7031.5,Businass and. Piofessions Code: Any city or, county which requires a '7.3 V V r� v
permit to construct, atter, improve, demolish, or repair any structure, prior to its issuance also I AMOUNT
requires the applicant for such permit to life a signed statement that he is licensed pursuant to - PERMIT -
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 Plan Chk. Dep.
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, Plan Chk. Bal.
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and Cionst. 5 QQ
Professions Code: The Contractor's License Law does not apply to an owner of property who
builds or improves thereon and who does such work himself or through his own employees, Mech. ,
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 Electrical
or proving that he did not build or knprove for the purpose of sale.) - -
❑ I, as owner of the property, am exclusively contracting. with licensed contractors to con- Plumbing
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 S.M.1. -
such projects with a contractors) ffcensed pursuant to the Contractor's License Law.) -
Grading
❑ 1 am exempt under Sec B. & P.C. for this reason
Driveway Enc.
Date Owner Infrastructure
WORKERS' COMPENSATION DECLARATION '
I hereby 'affirm that I have a certificate of consent to self -insure, or a certificate of
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.) -'
Policy No. Company
❑ Copy is filed with the city. ❑ Certified copy is hereby furnished.
TOTAL
CERTIFICATE OF EXEMPTION FROM REMARKS /j 1
WORKERS' COMPENSATION INSURANCE /
(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 lhp work for which this permit is issued, I shall not /A -,,,/a1 ! ,/,T ,,_
employ any person in any manner so as to become subject to the Workers' Compensation e !
Laws of Cah(0 nia 1
Date Owner 11
NOTICE TO APPLICANT. ff, after making, this Certificate of Exemption you should become ZONE: BY:
subject 'to the Workers' Compensation provisions of the Labor Code, you must. forthwith
comply with such provisions or this permit shall be deemed revoked. Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
WARNING: FAILURE TO SECURE WORKERS'.COMPENSATION COVERAGE IS UNLAWFUL, AND Side Street Setback from Center Line,-
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, Side Setback from Property Line
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 • FINAL DATE INSPECTOR
expiration if work thereunder is suspended for 180 days.
I cer Illy that I have read this application and state that the above information is correct. Issued by: Date Permit
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. Validated by:
Signature of applicant -Date-
Mailing
ateMailing, Address Validation:
City, State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBINU FEES
IST FL. SO. FT. ® $
2ND FL. SO. FT. p
POR. SO. FT. ®
GAR. SO. FT. ®
CAR P. I SO. FT.
WALL SO. FT. ®
SO. FT. ®
ESTIMATED CONSTPUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN,
URINAL
WATER PIPING
NOTE: Not to be usec as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
HEATING (ROUGH)
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
DUCT WORK
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
1
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.
SO. FT. ® c
BATH TUB
BOND BEAM .-
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, S.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
LUMBER GR.
SO.FT.GAR ® 3/ac
HOUSE SEWER
FRAMING
FINAL INSP.
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
GROUND PLUMBING
UNDERGROUND
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
OUND. REINF. —
1
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
GAS (FINAL)
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
REMARKS:
VENTILATION
FIRE ZONE ROOFING'
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL