14872 (BLCK)c —
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44
P.O. BOX 1504 No. 14872
Building' 78-495 CALLE TAMPICO
Address _46-6-2'r—Washington St. LA QUINTA, CALIFORNIA 92253
Owner
Thomas Gasi.11as
Mailing BUILDING: TYPE CONST.. OCC: GRP.
Address Same
A.P. Number
City Zip Tel.
-La 4„ uirita A 92253 564--1567 Legal Description 71 r
Contractor Project Description �£ 5 "high garden block
Owner/Builder walk. and 651-6" of V high garden blocX Kat?
Address
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) t. of Division 3 of the Business and Professions Code, and my license is in full force and
effec-
�x.
SIGNATURE .,t" DATE
OWNER -BUILDER DECLARATION
z
I hereby affirm that I am exempt from the Contractor's License Law for the following.
reason: (Sec. 7031.5,Buslness and'-Professlons Code: Any city or county which requires a
permit to construct, atter, Improve, demolish, or repair -any structure, prior to its issuance also
requires the applicant for suchrpermlt 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 that. he is exempt therefrom, and the basis
for the alleged exemption. ;Any violation of Section 7031.5 ,Dy 'any applicant for a permit
subjects he applicant to a civil°penalty of not more than five hundred dollars (5500).
�I a owner of the property; or my employees with wages as,their sole compensation, will .
d the work, and the structures not intended or offered for sale. (Sec. 7044, Buisness and
Prot sslons Code: The Contractors 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 ares not Intended or offered for sale. I/; however, the building
or Improvement is sold wither one year,.o/ completion, the owner -builder will have the burden
ofproving that he did not buil/ or enprove for the purpose o/sale:) -
Estimated Valuation $3,163.00 �"�.""� � , s
Z 3
' PERMIT - AMOUNT .
Plan Chk. Dep. -
Plan Chk. Bal.
COr1St.63.013
Mech.
'
Electrical -
Plumbing
O 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 o/ property who builds or improves thereon, and who contracts for
such projects with a contractor(s) #tensed pursuant to the Contractor's License Law.)
11I am exempt under Sec. 1-8XP.C. for this reason
S.M.I.
_
Grading
Driveway Enc.
<wner f fv�'
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 No. Company
❑ Copy is filed with the city,-- ❑ Certified copy is hereby furnished.
TOTAL 63.001 _5+o_00
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
REMARKS
(This section need not be completed it the permit Is for one hundred dollars ($100) valuation
' or less.)
I certify that in the performancg�of t R wof/Pfer which this permit is issued, I shall not
mploy any, person in any man erso,� to bet om subject to the Workers' Compensation
aws�f�Califortr • ��''' 1
-
4at.
O�nerOTIate of Exemptbn- you should become
to Me Workers' Compensation provisions o! the Labor Code, you must • forthwith,-
comply with such provisions or this permit shall be deemed revoked. '
ZONE: - BY:ub)ect - -
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
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, -Side
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE; INTEREST, AND
Side Street Setback from Line
Setback from-.. r— ? ne
" '
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.
!,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.
= r-
FINAL DATE INSP
y •.
Issued by: Date =� it
1
r
Validated by: . r 1 y' .•
Signature of applicant Date
Mailing Address
Validation:
;
City, State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBIW FEES ^. ti
IST FL. SO. FT. ® $
2ND FL. SO. FT.
POR. SO. FT. ®
GAR. SO. FT. ®
CARP. SO. FT.
WALL SO. FT. ®
SO. 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
BONDING
FLOOR DRAIN
MECHANICAL FEES
FORMS
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH) •
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APPJEOUIP.
LAUNDRYTRAY
AIR HANDLING UNIT CFM
TEMP. POLE
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
/� ►" �e��� ._
=
_
SO.FT.GAR ® 3/ic
HOUSE SEWER
VENTILATION
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 3f% �%�
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
_$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
/� ►" �e��� ._
=
_
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
BUILDI AFETY DEPA TMENT
CON NALLY
ACCEPTED FOR C RUC ION
�( SUBJECT TO INSTALLATIC V ER
AND ALL APPLICABLE C DE
3 (000, DATE
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