14615 (RR)J r .
'u t
.f .
4
P.O. BOX 1504
Building 5 -673 Ave. Velasco 78-495 CALLE TAMPICO
Address LA QUINTA, CALIFORNIA 92253
Owner. _ ..
Marcia Andreae.
No. 14615
BUILDING: TYPE CONST..
A.P. Number
OCC: GRP.
Mailing "
Address ame
City
Zip
Tel.
La. QujLIDta411' CA
92253
564-4688*
Legal Description
Project Description -
ContractorReroof
owniir/Builder
Address
City'
Zip
Tel.:
State Lic.
City
& Classif..
Lic. #
Sq. Ft.
No.- No. Dw.
Size -
Stories Units
Arch., Engr., ...
' Designer
New ❑ Add O.:'
Alter O Repair ❑ Demolition ❑
Address
Tel.
City
Zip
State
_.
Lic. #
LICENSED CONTRACTOR'S DECLARATION
- - - -
I hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing with Section
- 7000) of Division 3 of the Business and Professions Code, and my license is in full force -and -
orce.and'effect.
effect .
'
SIGNATURE DATE
OWNER -BUILDER DECLARATION -
1 hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Business and Professions .Code: Any city or county which, requires- a
Estimated VdhlatlOnnnn��rr
� I v it/. !� V �
..
1
PERMIT
'
AMOUNT
permit to construct, atter, Improve, demolish, or repair any structure, prior,to its issuance also
'requires the applicant for such permit to rile a signedstatementthat 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 td a civil penalty of not more than -rive hundred dollars ($500).. "• .'
I, as owner of the property, or my employees.with wages as their sole compensation, will
,itdo 'twork, 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
Plan Chk. Dep.
'
Plan Chk. Bal.
Const. -
�i a �L�
Mech..
builds or improves thereonand 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 knprove.for the purpose of sale.) __ -
Electrical
Plumbing
❑'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 contractor(s).pcensed pursuant to the Contractor's License Law.) -
❑ 1 am exempt under Sec.w - ` B. & P.C. for this reason
-
S.M:I. ..
•-•
.
Grading
,
Driveway Enc.
,ate =* Owner
Infrastructure
WO S' 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
30 ..0Q
CERTIFICATE OF EXEMPTION FROM `
WORKERS' COMPENSATION INSURANCE
REMARKS
-
(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 thg work for which this permit -is issued,.l shall not
employ any pperson in any manner so'as to becom .subject to the' Workers' Compensation - -
Laws of California. '• 7 1 4.
ate=Owner __ ✓
NOTICE TO APPLICANT: N„ ghdrmaking �thi Cermcate o`% Exemption you should become
bject to the Workers' Compensation pov�sions of the' Labor Code; you must forthwith .
complywifhsuchprovislonsorthispermitshalllbedeemed revoked. . -
�./
•ZONE: - BY:
Minimum Setback -Distances: - .•. ~
Front Setback from Center Line
Rear. Setback from Rear Prop. Line,
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,
-
'Side Street Setback from ,Center Line - -
Line
Side Setback from PropETOIR
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.This is a building permit`when properly filletl out, signed and validated; and is subject to
expiration if work thereunder is suspended for 180 days.
FINAL DATE
INSP (
I certify that I have read this application and state that the above information is correct.ISSUed.by:
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:
"'Date 'glrermit
1
Signature of applicant— Date
Mailing Address
Validation:
f 7r
City, State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING. FEES
1ST FL. SQ. FT. ® $
UNITS
SLAB GRADE
2ND FL. SO. FT. p
`BONDING
YARD SPKLR SYSTEM
STORAGE TANK
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
DUCT WORK
ROCKSTORAGE
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
HEATING (FINAL)
OTHER APPJEOUIP.
DRAINAGE PIPING
CAR P. SQ. FT.
TEMP. POLE
WALL SQ. FT.
GROUT
DRINKING FOUNTAIN.
SQ. FT. ®
FINAL INSP.
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER SYSTEM
WATER PIPING
NOTE: Not to be used as property tax valuation
.
=$
FLOOR DRAIN
MECHANICAL FEES
FINAL INSP.
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
VENTILATION
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
GAR. FIREWALL
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ic
HOUSE SEWER
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 I IHEATING & 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
ROCKSTORAGE
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.
$ 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 SIONATURcS/INITIALS
GARDEN WALL FINAL