15050 (RPL)P.O. BOX 1504 N 0 .
Building78-495 CALLE TAMPICO '
Address 78-970 La 'Palm LA QUINTA, CALIFORNIA 92253
Owner
Vic: Vickers
Mailing BUILDING: -TYPE -CONST. OCC: GRP: '
Address 7$.? 0- aka .Palma
A.P. Number
City La. Quinba zIp 92263 ' Tel.
Legal Description
Contractor.
sunrise Pooh .. Project Description Pool�Z
Address...
P.O., Box 12573
City Zip Tel.: t
Pa :Desert 92255 340-5521
State Llc. City
& Classic... C513--556236 Lic. # 1604 Sq. Ft. No.
Size Stories
-Arch','Engr.,'
Designer New ❑ Add O . Alter O
Address Tel:
City'. Zip State
Lica#
{ ,LICENSED CONTRACTOR'S DECLARATION
Lhereby affix that -Cam licensed underprovisions•of Chapter 9 (commencing with Section
7000).of Division 3 "f the Business and Professions Code, and•my license.is in.full force and
effectCf--
�GNATURE d 3 'DATE
OWNER -BUILDER DECLARATION.,
Estimated Valuation ;
I hereby affirm that I am exempt from the Contractor's License Law for the following ;a ��p�
' reason: 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 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
Divlslon=3 of, 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 civil penalty of not more than rive hundred dollars ($500).
❑ 1, 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 CoderThe Contractor's License Law does, not apply, to an owner of. property who
- PERMIT. �-
-
Plan Chk..Dep. -
Plan Chk. Bat.
Const. `
Mech.
bullds�or Improves thereon and who does such work himself or through hisownemployees,
provided that such improvements are not Intended or offered for.sale. A, however, the building
_
EI2CtrICdl
or improvement is sold within one -year -of completion, the - owner -builder: will have the burden
ofproving that he did not build or improve for the purpose of sale.).
Plumbing
O'I, as owner of the property, am exclusively contracting with licensed contractors to con-
" strucl. 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) flcensed pursuant to the Contractor's License Law.)
[]'I am exempt under Sec. B. 8 P.C. for this reason
S.M.L. - -
-
Grading.
Driveway Enc.
Date Owner
Infrastructure
WORKERS' COMPENSATION DECLARATION -
" I hereby affirm that I have a certificate of'consenf to: self -insure, or -a certificate of
' Worker's Compensation Insurance, or a certified copy thereof. (Sec. •3800, Labor Code.)..
< 1'i
Policy No. % 7-:'10 .Company . 2ili-4:.
4
.R'Copy is filed with the city,. -❑ Certified copy is hereby. furnished..
TOTAL
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 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
Data ' Owner
NOTICE TO APPLICANT., ff, after making, this Certificate o/ 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,
DAMAGES AS PROVIDED FORAN 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 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 Address
City, State, Zip
No. Dw.
Units "
AMOUNT
A SJ-E7.e is
�s•vv
REMARKS
-r.
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from•Rear Prop. Line
Side Stieet Setback from Center Line
Side Setback from Property Line
FINAL DATE INSPECTOR
Issued by: Date • i"
Validated by: n
1
Validation: _ nn A V " . 1.1gQG
U
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBIW%3 FEES
1ST FL. SO. FT. ® $
2ND FL. SO. FT.
POR. SO. FT. ®
GAR. SO. FT. ®
1'CAR P. SO. FT.
WALL SO. FT. ®
$O. FT. ®
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
GAS (ROUGH)
LAUNDRYTRAY
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.
SO. FT. ® c
BATH TUB
BOND BEAM
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11A c
SEWAGE DISPOSAL
LUMBER GR.
SO.FT.GAR ® V4c
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
i
A.C. UNIT :
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
1
HEATING (ROUGH) --
STORAGE TANK
FORMS
SEWER OR SEPTI
AN
ROUGH .WIRIN
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL) .
OTHER APPJEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATERHEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
'FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
U
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