14399 (PLBG)P.O. BOX 1504
Building 78-495 CALLE TAMPICO
Address 51-725 Ave. Diaz LA QUINTA, CALIFORNIA 92253
Owner ,fir. & Mrs. David Lopez
Mailing
Address Sate
CityZip Tel,
La Quinta,. CA 92253
Contrator
WncbQer Engineering & Construction
Aid,VR1.75 Berros Court-
-
cictyathedrai• Cit z p CA 52234 TetZ19) 327-2200
No. 14399
WING: TYPE CONST. OCC: GRP.
P. Number
_egal Description
Sewer -Connect
project Description
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 N Pr Company
EL,Cbpy Is -filed with the city. ❑. Certified copy is hereby furnished. -
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed N the permit Is for one. hundred dollars ($100) valuation
or less.)
I certify that in the 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 Cald0 nia.
Date � Owner
NOTICE TO APPLICANT: N, 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 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 property 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
TOTAL _ 30.OU
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 Permit t
Validated by: `t\
V,
Validation: \ V �,
State Lic.
City
i£ Classif.. A B 684553
Lic. #
Sq. Ft.
No. No. Dw.
Size
Stories • Units
Arch., Engr., • � '•
Designer
New ❑ Add ❑•
Alter ❑ Repair ❑ Demolition ❑
Address
Tel.
City
Zip
State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
t I her ,affirm that I am licensed under pro$1sions of Chapter 9'(commencing with Section '
000) of ivision 3,`of the Business and'Professtons Code; and my license is n•fu11 force and
effect? /ll All
3LGNATURP"' �' Y `i .f y DATE
OWNER -BUILDER DECLARATION
_
Estimated Valuation
I hereby affirm that I am exempt from the Contractors License Law for the following
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a
permit to construct, atter, improve, demolish, or repair any structure, prior. to Its issuance also
.. I
requires the applicant for such permit to rile a signed statement that he is licensed pursuant to
PERMIT
AMOUNT
the provisions of the Contractors License Law, Chapter 9 (commencing with Section 7000) of
Division 3 of the Business and Professions Code, or that. he is exempt therefrom, and the basis
for the Any Section 7031.5 by 'any for
Plan Chk..De p
alleged exemption. violation of applicant a permit
subjects the applicant to a civil penally of not more than rive.hundred dollars ($500). - '•
.
Plan. Chk. Bal.
O 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 .
Const.
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,
Mech.
.
provided that such improvements are not intended or offered. for sale. If, however, the building
orimprovement is sold within one year or completion, the owner -builder will have the burden
Electrical
of proving that he did not build or improve for the purpose of sale.)
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-
Plumbing
d +
struct the project. (Sec. 7044, Business and.Professions Code: -The Contractor's License Law
,
does not apply to an owner or property who*buUds or improves thereon, and who -contracts for
S.M.I.
such projects with a contractor(s) pcensed pursuant to the Contractor's License Law.)
_
Grading
❑ I am exempt under Sec. B. 8 P.C. for this reason
Driveway Enc.
Date Owner
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 N Pr Company
EL,Cbpy Is -filed with the city. ❑. Certified copy is hereby furnished. -
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed N the permit Is for one. hundred dollars ($100) valuation
or less.)
I certify that in the 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 Cald0 nia.
Date � Owner
NOTICE TO APPLICANT: N, 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 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 property 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
TOTAL _ 30.OU
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 Permit t
Validated by: `t\
V,
Validation: \ V �,
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBINU FEES
1ST FL. SO. 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
FOR. SO. FT. ®
GAS (ROUGH)
METER LOOP
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
GAS (FINAL)
TEMP. POLE
DRAINAGE PIPING
CAR P. I 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
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
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
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
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 OR SEPTIC TANK
ROUGH WIRING
'DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP./EOUIP.
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 SIt3NATURESIINITIALS
GARDEN WALL FINAL