14952 (AR)f
B 'Id•
Address 78-685 Ave. Ultimo
Owner Michiel D2etrick
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Mailing ;
Address 81-960 Ave. Herrera
City Zip Tel.
La Quint a; CA 92253 871-1561
Contractor
same
Address .
City ; Zip Tel.'
State Lic. i1 8 ° 22 City
& Classif. 6Lic. # 323
Arch., Engr.,
Designer
Address Tel.
City Zip State
Lic. #
LICENSED.CONTRACTOR'S DECLARATION
I hereby affirm that Pam licensed under vrov(Sions of Chapter 9 (commencing with Section '
of DivisionIg43 of the Busines and Pr ofession`s�Coile and my license is i full, force and
\reffect JIt"t p, " � 16 1,/."
'$LGNATURE .4 DATE
'OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractors License Law for the following
.reason: (Sec. 7031.5,Suslness and Professions Code: Any .city or county which requires a
permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance also.
requires 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
P
Division 3 or 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 chill 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
do the work, and the structureAs not intended or offered for sale. (Sec. 7044; Buisness and
Professions Code: The Contractor's. License Law does not apply to an owner or property who
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.)
O 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
such projects with a contractor(s) (lcensed pursuant to the Contractor's License Law.) `
O 1 am exempt under Sec. B. & P.C. for this reason
Date Owner
r
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.)
Policryo, Company
Er'Copy.is filed with the city. . ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the perm POfor 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. If, 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,-
DAMAGESdAS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, -INTEREST, AND.
ATTORNLY'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 160 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.
Signature of applicant -Date-
Mailing.
ateMailing. Address
City, State, Zip
No. 1.4952
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number 769-x062-004
Legal Description
Project Description Guest Hofilse
Sq. Ft. No. No. Dw.
Size 320 Stories - Units -
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
ZONE: • BY:
Minimum Setback Distances:
Front Setback from Cent L"n
Rear Setback from Re' p. Li
Side Street Setbaa Cen
Side Setback fr, m Prop>rtty in •/ \
FINAL DATE T SPECTO�/
Issued by: Date
Validated by: cS /
Validation:
4
Estimated Valuation, , 417,376.00
PERMIT.
AMOUNT
Plan Chk. Dep. .
Plan Chk. Bal.
169.19.
Const.
189.'00
Mech.
52.50 ,
'Electrical
44.70
Plumbing
39.00
S. M.I.
1.74
Grading
20.00
Driveway Enc.
Infrastructure,
TOTAL
516.13
REMARKS
ZONE: • BY:
Minimum Setback Distances:
Front Setback from Cent L"n
Rear Setback from Re' p. Li
Side Street Setbaa Cen
Side Setback fr, m Prop>rtty in •/ \
FINAL DATE T SPECTO�/
Issued by: Date
Validated by: cS /
Validation:
4
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PI,UMBINu
1ST FL. SO. FT. @ $
UNITS
COLL. AREA
2ND FL. SQ. FT.
YARD SPKLR SYSTEM
BONDING
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. @
FORMS
GAR. SO. FT. @
POWER OUTLET
ROOF DRAINS
ROCK STORAGE
DRAINAGE PIPING
CAR P. SO. FT.
GAS (ROUGH)
METER LOOP
WALL SO. FT.
DRINKING FOUNTAIN.
SO. FT. @
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as properly tax valuation
GROUT
FLOOR DRAIN
MECHANICAL FEES
SERVICE
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
WATER SYSTEM
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
,
x$ _$
LAUNDRYTRAY
AIR HANDLING UNIT CFM
FINAL INSP. 5'� 9s
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
FIRE ZONE ROOFING
SQ. FT. @ c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID @ 1% 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
-SMIFEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK �� L
GROUND PLUM p gS
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.
g plus
,
x$ _$
LUMBER GR.
FINAL INSP. 5'� 9s
FRAMING 9�
/
FINAL INSP.
ROOFING `Y
VENTILATION
ANIV lJ
REMARKS:
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND g
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL