15252 (BLCK)Building
Address
Owner
il
T,I
tyl
414
�.
` No. x.5252
P.O. BOX 1504
78-495 CALLE TAMPICO
78-710 Loa Palma. Dr.. LA QUINTA, CALIFORNIA 92253
jairtea' flanousek
Address ZaMi :
City Zip Tel.
La: dui ta, C A 92253 .360-6554
Contractor
Owner/Builder
Address
State Lic. City
& Classif.. Lic. #.
Arch., Engr.,
Designer
Address Tel.
CityI Zip I State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
)' of Division 3 of the Business and Professions Code, and my license is in full force and
fect.
`(SIGNATURE DATE
'OWNEWBUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractor's License Law for the following
reason:. (Sec. 7031.5,Sustness 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 file 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 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
subjects�the applicant to a civil penalty of not more than rive hundred dollars ($500).
ED ' s 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 of 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 orenprove for the purpose of sale.)
❑ 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 contractors) (fcensed pursuant to the Contractor's License Law.) -
❑ 1 am exempt under Sec. ` B 8 P.C. for this reason
rT s
P ••Date U-9 -M Owner Owner `i4t dtt ."'}"°'".'..'
•ti 7
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.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
.(This section need not be completed !f the. permit is for one hundred dollars ($100) valuation
or less.)
I certify that in'he ,performance of the work for which this permit is issued, I shall not
' employ any pperson in any manner so as¢to`become subject to the Workers' Compensation
�(laws of Call
fornia i t
t`Date'.i: I i Owner- _.
NOTICE TO APPLICANT: d, oiler making this Certl/irate o/ Exemptron you should become
subject to the Workers' Compensation provlslons - of the Labor Code, you must forthwith
comply with such provfslons 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 it work thereunder is suspended for 180 days.
I certlfy 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 r Date
Mailing Address
City, State, Zip
BUILDING: TYPE CONST. • •
A.P. Number
Legal Description
441
Project Description of 6*
black- wrill and 46 • ;;f
OCC: GRP.
high combination
6' high garden wa11
Sq. Ft. No.
Size - Stories
No. Dw.
Units
New ❑ Add -0 . Alter ❑
Repair ❑ Demolition ❑
Estimated Valuation
$3,500.00
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
63.00
Mech.
Electrical
Plumbing
f
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
:pU» , ..... . Q
REMARKS
ZONE: BY: '
Minimum Setback Distances:'
Front Setback from Center Line '
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from.Property.Line
FINAL DATE INSPECTOR
Issued by: Date PeTii 1
Validated
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBIW FEES
1ST FL. SO. FT. ® $
2ND FL. SO. FT.
POR. SO, FT, ®
GAR. SO. FT. ®
CAR P. SQ. FT.
WALL SO. FT. ®
SQ. FL ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
,
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN. "
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
HEATING (ROUGH)
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
DUCT WORK
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
HEATING (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.
SQ. FT. ® c
BATH TUB
BOND BEAM
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 1+/a c
SEWAGE DISPOSAL
LUMBER GR.
SO.FT.GAR ® 3/4c
HOUSE SEWER
FRAMING
FINAL INSP.
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
Q�
/
J r/
(�
pl
a
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
f--
n
PHASE
RON 1.7 Y1 C