15871 (PLBG)P.O. BOX 1504 No. 1587
Building78-495 CALLE TAMPICO
Address 54-x140 Ave Valli .Q . LA OUINTA, CALIFORNIA 92253
Owner
gober
'
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Mailing BUILDING: TYPE CONST. OCC: GRP.
Addresse
A.P. Number
City Zip Tel.
La Quinti 91253 564-0254 Legal Description
Contractor
Project Description
-Address =.a. :S..... A L
8 Men.
City Zip Tel.:
State Lic. City
& Classif.. Lic. # Sq. Ft. No. No. Dw.
Arch., Engr.,
Size Stories Units
Designer New ❑ Add ❑ Alter ❑ 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 Estimated Valuation
I 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
permit to construct, after, Improve, demolish, or repair any structure, prior to its issuance also
requires the applicant for such permit to,Rle a signed statement that he is -licensed pursuant to PERMIT AMOUNT'
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section .7000) of
Division 3 of the Business and Professions Code, or thathe is exempt therefrom, and the basis
for the alleged exemption. Any `violation of Section 7031.5 by 'any applicant for a permit Plan Chk. Dep.
subjects the applicant to a civil penalty of not more than five hundred dollars :($500). _ -
❑ I, as owner of the property, or my employees with wages.as.their sole compensation, will Plan Chk. Bal.
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and Const.
Professions Code: The Contractor's; License Law does not apply to an owner of property who - -
builds or Improves thereon and. who does such work himself or through his own employees, -Mach.
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 Electrical
or proving that he did not build or Improve for the purpose or sale.)
O I, as owner of the property,.am exclusively contracting with licensed contractors to corn Plumbing
slruct the project. (Sec. -7044, Business and Professions Code: The Contractor's License Law 33-50
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) #tensed pursuant to the Contractor's License Law.) .
O 1 am exempt under Sec B. & P.C.-foNhistieason Grading
A`<< f ' '• Driveway Enc.
Date' % Owner >- U Infrastructure
WORKERS' COMPENSATION DECLARATION
I hereby affirm that l'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.
O Copy is filed with the city, ❑ Certified copy is hereby furnished.
TOTAL
CERTIFICATE OF EXEMPTION FROM REMARKS
- WORKERS' COMPENSATION INSURANCE
(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 th work for which this ermit is issued I shall not
' employ any pperson in any manner so as to become subject to the Workers' Compensation
Laws of California
Date Owner
NOTICE TO APPLICANT, fl, after ,making this Certificate of Exemption you should become
ZONE:
BY:-
subject to the Workers' Compensation provisions of the Labor Code; you must forthwith
Comply with such provisions or this permit shall be deemed revoked.
Minimum Setback Distances: .
'
Front Setback from Center Line '
Rear Setback from Rear Prop. Line
WARNING: FAILURE TO SECURE WOR KERS' COMPENSATION COVERAGE IS UNLAWFUL, AND '•
Side Street Setback from Center Line
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 Setback from Property Line r
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE' LABOR.CODE, INTEREST, AND
ATTORNEY'S FEES.
FINAL DATE
INSPECTOR
This is a building permit when properly filled out, signed and validated; and is subject to
expiration if work thereunder is suspended,forJ80 days. .
I certify that I have read this application and state that the above inforination 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-,
it
mentioned property for inspection purposes:
Validated by:
Signature of applicant Date
Mailing Address
Validation:
City, State, ZipUG
1j
gy
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBIW FEES
1ST FL. SO. FT. ® $
UNITS
SLAB GRADE
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL. SO. FT.
FORMS
SEWER S
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
GAS (ROUGH) •
METER LOOP
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
GAS (FINAL)
TEMP. POLE
DRAINAGE PIPING
CARP. SO. FT.
GROUT
WATER HEATER
WALL SO. FT.
FINAL INSP.
DRINKING FOUNTAIN,
SO. FT. ®
WATER SYSTEM
URINAL
ESTIMATED CONSTRUCTION VALUATION $
_$
WATER PIPING
NOTE: Not to be used as property tax valuation
FRAMING
FLOOR DRAIN
MECHANICAL FEES
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
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 ® 11/4 c
SEWAGE DISPOSAL
INSULATIONISOUND
SO.FT.GAR ® 3/ac
HOUSE SEWER
FINISH GRADING
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 S
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.
/11/a / Q� FINAL INSP.
FRAMING
FINAL INSP. �/A,00S
ROOFING
r -
REMARKS:
VENTILATION
FIRE ZONE ROOFING '
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING.
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL -
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
,EC.®NO SEWER SERVICES
P.O. Box 192
PALM DESERT, CALIFORNIA 92261
46379
FHUNL 3ZU-//bU 34b-Z/J3
TOTAL MATERIALS
CUSTOMER'S ORDER NO.
PHONE
.MEC C
HELPER
STARTING DATE
TAX
DATE COMPLETED
BILL TO
ORDER TAKEN BY
C
ADDRESS
• ❑ DAY WORK
CIT ❑ CONTRACT-
/ ❑ EXTRA
JOB NAME AND LOCATION J
JOB PHONE >'
PAYMENT TERMS NET 10 DAYS FROM DATE OF SERVICE
1%% PER MONTH CHARGE AFTER 30 DAYS
❑ No one home .❑ Total amount due ❑ To I billing to
?"�•
Signature for above work or be mailed after
completion
PflfllMlff 75iF7. Int I harohp orYnm�doAQo tho roHrfnrtnry emmpl®firm I - Of work '
Gmton MSao1471. of the above described work
TOTAL MATERIALS
'
TOTALLASOR
NO STATEMENT WILL BE MAILED
TAX
DATE COMPLETED
WORK ORDERED BY
TOTALAMOUNT
S _
❑ No one home .❑ Total amount due ❑ To I billing to
?"�•
Signature for above work or be mailed after
completion
PflfllMlff 75iF7. Int I harohp orYnm�doAQo tho roHrfnrtnry emmpl®firm I - Of work '
Gmton MSao1471. of the above described work