15212 (INST)=• P.O. BOX 1504 No. 15212
Building 78-495 CALLE TAMPICO
,Address 4 48-539 Via Amistad LA QUINTA, CALIFORNIA 92253
Owner Bert McCarthy
Mailing
Address Same
CityZip
. La. _Quint; -CA 92253
Contractor
. Larxy"Gumtz Const.
Address
.78365 RW III, Ste. 14.8
cBQu4&hta,. CA zip
Ba
92253
State Lic.
& Classif. Lk 424048
Arch., Engr.,
`Designer
Address
el.
BUILDING: TYPE CONST.. I - OCC: GRP:
Number
Legal Description
Project Description Install 32" X 40" glass
block window in . master hath
City
Lic. # 2789 .' Sq. Ft. C `No. No. Dw.
Size Stories Units
New ❑ Add. ❑. Alter. ❑ Repair ❑ Demolition ❑
Tel.
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION ..
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section,
7 of Division 3 of the Business and:Professions Code, and my license is in full force and
.�'�-�"�'t✓Z��-
�%GNATURE r DATE
OWNER -BUILDER DECLARA ION
I hereby affirm that I am exempt from the Contractor's License Law for the following .
reason:.(Sec. 7031.5,Bustness 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 o/ the Contractor's Ltcensee,Law, Chapter 9 (commencing with- Section 7000) of
Division 3 o the Business and Professions Code, or thalhe is exempt therefrom, and the basis
lot the alleged exemption- Any violation o1 Section 7031.5. by 'any applicant for a permit
subjects the applicant to a civil penatty b)'not more than five hundred dollars ($500).
❑ 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, 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
o/ proving that he did not build or knprove for the purpose of sale.) -
❑ 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 contractors) licensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec. B. & P.C. -for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self -insure, or a certificate of
Workers 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.
CERTIFICATE OF EXEMPTION FROM
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 o_f the work for which this permit is issued, I. shall not
employ any pperson in any manner so as to become subject:tofthe Workers' C mpensation
Laws of Califoinl 4�r�. ,/� ,ref �q N�+� y,r"
Date�f7�d �� Owner' / . fr Ti'r o�'�s x r✓��r"l /� T
T/CE TO APPLICANT: 'fl after -akin Nf �Certcate'� o/ Exemption you should become
subject to - the Workers' Compensation prof sforfs o/ the labor Code, W 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,
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
expiration if work thereunder is suspended for 180.days.
I certify that I have read thisapplicationand 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 Address
City, State, Zip
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback fromo ea�r. Prop. Line
Side Street Set/b/a///�� rom`Genter Line
Side Setback fff 1)ropq;1y Line
FINAL DATE
Issued by:
Validated by:
Estimated Valuation $400.00
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
15.00
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
15.00
.REMARKS
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback fromo ea�r. Prop. Line
Side Street Set/b/a///�� rom`Genter Line
Side Setback fff 1)ropq;1y Line
FINAL DATE
Issued by:
Validated by:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBIW FEES
IST FL. SQ. FT. @ $
UNITS
SLAB GRADE
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL. SO. FT.
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. @
GAS (ROUGH)
METER LOOP
GAR. SO. FT. @
POWER OUTLET
ROOF DRAINS 1
GAS (FINAL)
TEMP. POLE
DRAINAGE PIPING
CAR P. SO. FT. @
GROUT •
WATER HEATER
WALL SQ. FT.
FINAL INSP.
DRINKING FOUNTAIN.
SQ. FT. @
WATER SYSTEM
URINAL
ESTIMATED CONSTRUCTION VALUATION $
_$
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
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
FIRE ZONE ROOFING
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.
SQ. FT. @ c
BATH TUB
LATHING
SO. FT. @ c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID @ 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR @ 3/ac
HOUSE SEWER
FINISH GRADING
FINAL INSPECTION
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 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 SIONATURESlINITIALS
GARDEN WALL FINAL