14262 (BLCK)Ah0YO///��/// f
P.O. BOX 1504 N o. 14262
Building 78-495 CALLE TAMPICO
Address r •s, LA OUINTA, CALIFORNIA 92253
Owner
Mailing
_ BUILDING:.TYPE CONST. OCC. GRP.
Address ,,AIME A.P. Number
City Zip Tel.
La Quinti 92253 1 564-2537 J Legal Description
Contractor Project Description StUCCO Wall ,
Mobile Concrete ��i Q Total
Address (40'-4' Wa11 (10' -5' Wa1111
City
La 0
State Lic.
& Classif. C_
Arch., Engr.,
Designer Mel
Address
to 1 92253
Tel.
564-652
City
Lic. #
Tel.
Sq. Ft.
Size
No. No. Dw,
Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
.✓..�`
Front Setback fro n or Line
_
City
Zip
State
e Street Setback from Center Line
SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE
I
-
Lic. #
Side Setback from Property Line
LICENSED CONTRACTOR'S DECLARATION
-'r•+
,
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of the Business and Professi
effect. ons Code, and my license is in full torte and
..
-
This is a building permit when properly filled out, signed and validated, and is subject to
SIGNATURE DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5.Susiness and Professions Code: Any city or county which requires a
' permit to construct, after, 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 3 of the Business and Professions Coder 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
Estimated Valuation ¢
��J6 OQ
PERMIT
AMOUNT
Plan Chk. Dep. -
'
-
subjects the applicant to a civil penalty of not more than rive hundred dollars ($500).
tLas owner of the property, or my employees with wages as their sole compensation, will
Plan Chk. Bal.
•r
Const. Y
-
25. 0 - -
do The work, 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
Mech.
'
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
Electrical
• 'T,
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) licensed pursuant to the Contractor's License Law.)
_I am exempt under Sec. -B.'& P.C. for this reason '
Plumbing
a*S°
.: S. M. 1.
s '
Grading
'• 1
Driveway Enc.
r
/� r'
44
' Date pfll+ d v wner
r r
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. ❑ Certified copy is hereby furnished.
TOTAL
25 QO
REMARKS
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
' ZONE:
- :• 1 /
Minimum S ack Is1anG2S7
.
(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, 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 shaf/be deemed revoked.
City, State. Zip
Front Setback fro n or Line
_
Re c ear Prop. Line
WARNING: FAILURE TO SECURE WORKERS'COMPENSATIONCOVERAGE ISUNLAWFUL, AND
e Street Setback from Center Line
SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE
I
-
HUNDRED THOUSAND DOLLARS ($1D0,Do0), 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 certify 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 Address
Validation:
City, State. Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBINU FEES
IST FL. SO. FT. ® $
2ND FL. S0. FT.
POR. SO. FT. ®
GAR. SO. FT. ®
CAR P. SO. FT. ®
WALL SO. FT. ®
SO. FT. ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
I
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN,
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
BONDING
FLOOR DRAIN
MECHANICAL FEES
FORMS
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FOUND. REINF.
GARBAGE DISPOSAL !
FURNACE UNIT WALL FLOOR SUSPENDED
HEATING (FINAL)
LAUNDRYTRAY
AIR HANDLING UNIT CFM
GAS (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
LUMBER GR.
SO. FT. @ c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® t Vi c
SEWAGE DISPOSAL
ROOFING r l
SC.FT.GAR ® 3/.c
HOUSE SEWER
REMARKS:
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
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP.IEOUIP.
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 /J�
y
�FI L INSP.
ROOFING r l
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