14504 (BLCK)!TAi!t
i I
P.O. BOX 1504
Building ( 78-495 CALLE TAMPICO
Address 52-414 Ave. Velasco LA QUINTA, CALIFORNIA 92253
No. 145,04
Owner Lisa a 'Steve Dempton
BUILDING: -TYPE CONST: - •• OCC: GRP.
Mailing 71438.' Halgar Ad
Address `
A.P. Number
City Zip Tel.
Rancho.. Mirage CA 92270 3.46-0317. Legal Description
Contractor64' . of 6' high wood, fence ..
Project Description ,
Address.. _
City
Zip
Tel.:
State Lic.
City
& Classif..
Lic. #
Sq. Ft.
No. - No. Dw.
Size
Stories Units
Arch:, Engr:,
Designer
New ❑ Add ❑
Alter O .. ' Repair ❑ Demolition ❑
Address
Tel:
City
Zip
State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
_'•
I hereby affirm that I 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.
' effect.
SIGNATURE - DATE
OWNER -BUILDER DECLARATION '
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
ES1lmated Valuation
$510.00
- -
'�•
.. .PERMIT -
AMOUNT - --
permit to construct, atter, Improve, demolish, or repair any structure, prior to its issuance alsorequires the applicant for such permit to rile 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 Busineis and Professions Code• or that. he is exempt therefrom, and the basis
for the alleged exemption. Anyviolation of Section 7031.5 by 'any applicant for a permit.
' sub ec ,the applicant to's civil peri of not more than five hundred dollars ($500).-
10 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, Suisness and
Professions. Code: The Contractor's. License Law does not apply to an* owner or property who
Plan Chk.,Dep. .
'
Plan Chk: Bal.
Const.
25.00,-
5 . $0- _
Mach.
builds 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.)
Electrical
Plumbing -
❑ I, 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
.. S.M.I.
such projects with a contractors) licensed pursuant to the Contractor's License Law.) -
O 1 am exempt under Sec B. & P.C. for. this reason '
,r
Grading
'
Driveway Enc.
� f
l Datej: r • (t t� Owner ' �I c tii f'ev�
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
0-Copy.is filed with the city, O Certified copy is hereby furnished.
TOTAL
r
CERTIFICATE OF EXEMPTION FROM
• WORKERS' COMPENSATION INSURANCE
(This section need'not be completed ff the permit is for one hundred dollars ($100) valuation.
' or less.) y.-,
I certify that in the performance'of the work for which this/permit is issued, I shall not
mploy any parson in any manner`so as'to''become subject tof the Workers' Compensation
aws)of California ! . t i r:
Dater .. •. y. r. •Owner j `�' ivi ,! �{V .,; (/'L�i'1r }�.1
NOTICE TO APPLICANT: ff,`after making this Certificate of -Exemption you. should become.
subject to the Workers' Comperisauon provisions' of • the Labor Code,' you' must forthwith
comply with such provisions or this permit shall be'deemed revoked.
REMARKS
- li V
_
- .
ZONE: -BY: • 1 "�
Mlnirnum Setback Distances: '
Front Setback from'Center Line h
Rear Setback from Rear Prop. Line•
• . WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND
' SHALL SUBJECT -AN EMPLOYER TO CRIMINAL PENALTIESAND CIVIL FINES UP TO ONE'
Side Street Setback from Center Line
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 perm)t'when properly filled out, signed and validated, and is subject to "
expiration if work thereunder is suspended for 180 days..
I 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.
FINAL DATE
Issued by:
-
Validated by:
INSPECTOR
Date Permit
-
" Signature of applicant Date
.Mailing.Address
Validation:
' •'
City, State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
}
2ND FL. SO. FT. p'
BONDING
YARD SPKLR SYSTEM
STORAGE TANK
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
DUCT WORK
ROCKSTORAGE
GAR. S0. FT.
POWER OUTLET
ROOF DRAINS S
HEATING (FINAL)
OTHER APPJEOUIP.
DRAINAGE PIPING
CAR P. SO. FT.
TEMP. POLE
WALL SO. FT. ®
GROUT
DRINKING FOUNTAIN.
SO. 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
LAUNDRY TRAY
AIR HANDLING UNIT CFM
I
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
GAR. FIREWALL
SO. 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 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
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
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL