14555 (PLBG)A drress 53565 AVE CORTEZ
Owner
BZ HORN
Mailing
Address 53565 AVE CORTEZ
City
.. LA . QUINTA
Toy/
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
912253 1
. AFRICAN SERVICES
r s .
No. 14555
BUILDING:- TYPE CONST. OCC. GRP.
A.P. Number
Legal Description
Project Description 51 ISS E��FQ' L P.
74 91 JONI DR. 143
City��� - . _Zip
PAM DERSERT'
92260
Tel.:
58-1150
State Lic.
ruictfa
&ClassiL57914() C20 & C36
7
Sq. Ft. No. No: Dw.
Size Stories Units
Arch., ETtgr.,
Designer
New ❑ Add O . Alter El Repair IT- Demolition O
Address
Tel.
City
Zip
State
Lic. #
LICENSED CONTRACTOR'S DECLARATION .
I hereby, afflrrn that'I am licensed under provisions of Chapter 9 (commencing with Section -
70)1>) of Division 3 of the Business and Professions Code, and my license is in full force and-
.. effect.
-
StGNATl1RE DATE
OWNEWBUILDER DECLARATION
I herebyaffirin that 1 am exempt from the Contractor's License Law for the following
reason: (Sec..7031.5,Bushm and Professions Code: Any. city jot county which requires a
. permit to construct, alter, improve, demofiM. or repair any structure, Prior to Its Issuance also
requires, the appu th I for such permit to We a s, ed statement that he Is licensed pursuant to
the provbbrms o/ the Contractor's License taw, Chapter -9 (cornmenckhg with Section 7000) of
- Division 3 0l the Business and Professions Code, or that. he la exempt tirerelrormh, end the basis
- for - the alleged exemption. Any violation of 'Section 7031:5 by any ampgcant for a permit
subjects the appUcarht to a c1W penalty of not more than live hundred dollars ($500).
0 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, Bulsoess and
Professions. Code: The Contractor'sLicense Law does not appy to an owner of property who
builds, or Improves thereon and who does such work himself or through his own employees, IMech
provided that such Improvements are. not Intended or offered for sale. g,- however, the bud
orhrprorovernent Is sold wifhlh one year of Cortpletion, the owner -builder will have the burden
of proving that he did notbuild lir inprove for We purpose of sale.) .
0 1, as owner of the property, am exclusively contracting with licensed contractors to cot►
struct the project (Sec. 7044, Business and •Professions Code: The Contractor's License -Law
does -not apply to an, owner of properly .who builds or.krproves thereon, and who contracts for
such projects with a conirattor(aJ /tensed pursuant to the Contractor's License Law.)
❑ 1 am exempt, under Sec_ a, g. P.C. for this reason
Estimated Valuatio
. PERMIT AMOUNT .
-
. Plan Chk. Dep. -
Plan CW Bal.
Const. U
.ding -
Electrical - - -
Plumbing 3.00
S.M.1:
Grading
Driveway Enc.
Date Oar
Infrastructure
WORKERS' COMPENSATION DECLARATION
Ihereby affirm that I have a certificate of consent to self -Insure, or a certificate of
Worker s Compensatlon Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No Company
: ❑ Copy is flied with the city, ❑.Certified copy Is herebyfumished.
TOTAL •
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
REMARKS
-
(This .section need not be completed N Me permit Is for one hundred do8ars ($100) valuation
or less.) '
I certify that in the performance of the work for which this permit is Issued, I shall not
employarry ppeerson in any manner so as to become subject to the Workers' Compensation
laws of Cehfomla
Date ' Owner
NOTICE TO APPLICANT; It, after malting this Certificate of Exemption you should become
subject to the tAbrkera' Compensation provisions of Me Labor Code, you must forthwith -
compvwith such prormansor.uNspermit be doomed revoked.
ZONE: BY:
-
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGEISUNLAWFUL,'AND
SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND. CML FINES UP .TO ONE
HUNDRED THOUSAND DOLLARS ($IOO,ODO), IN ADDITION TO.THE COST OF COMPENSATION,
'Side Street -Setback from Center Line
Side Setback from Property Line
DAMAGES AS PROVIDED FOR IN SECTION 3705 OF THE LABOR CODE, INTEREST; AND
ATTORNEY'S FEES.
This is a building permit when property filled out, signed and validated, and is subject to'
FINAL DATE INSPECTOR
expiration if work thereunder is suspended for 180 days.
1 certify that I have read this application and state that the above information is correct.
construction,aetoComply herhe all city and county ordinances and state laws relating. to building -
mentioned' property by authorize representatives of this city to enter the above-.
p perty for Inspection -purposes.
Signature of applicant Date
Mailing Address
City, State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING fEES
IST FL. SO. FT. ® E
UNITS
SLAB GRADE
2ND FL.SO. FT.
BONDING
YARD SPKLR SYSTEM
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
J,ROOF DRAINS
CAR P. I SO. FT. ®
GAS (ROUGH)
DRAINAGE PIPING
WALL SO. FT.
OTHER'APPJEOUIP.
DRINKING FOUNTAIN.
SO. FT ®
TEMP. POLE
URINAL
ESTIMATED CONSTRUCTION VALUATION E
GROUT*
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SYSTEM
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FRAMING
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
REMARKS:
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET'
COMPRESSOR HP
POLE,TEMIPERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SO. FT. c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1% c
SEWAGE DISPOSAL
SO.FT.GAR ® Vic
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT LFEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEEELECT. 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
FOUND. REINF.
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.
s Pius xi
=$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL,INSP. Lf 9s'
/
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
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CITY OF LA Q U I NTA
BUILDING & SAFETY DEPARTMENT
CONDITIONALLY
ACCEPTED FOR CLNSTAUCTION
SUBJECT TO INSTALLATION AS PER
AND ALL APPLICA®LE nD S
_�� �'S"'
DATE BY
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