14518 (SIGN)P.O. BOX 1504 No. 14518
Building 78-495 CALLE TAMPICO
Address 50-855 Weehington 00 LA QUINTA, CALIFORNIA 92253
Owner
John Wassenmiller
BUILDING: TYPE CONST. OCC*..GRP.-.
Mailing
Address SaMe
A P Number
CitylZip
La.Quinta,.-CAJ.'.92253
Contractor
skghs & Services
Address...
.10980 S6atman Ave.
CR.t Z-10 -
a,nxto;t CA 90680
State Lic. , C,-.45 *439828
& Classif..
Arch.-,Engr.,
Designer
Address
360-0,650
Legal Description
"
Project Description CabinetSign
.La-Quinta...Village Dental
1`714) 761-8200
City
Lic. # 3543 Sq. Ft.
'7 -Size
New 0
No.
Add 0 Alter. 0
No. Dw
Units
Repair 0
-Demolition 0
City
Zip
State
Lic.. #
LICENSED CO NTRACTOR'.S DECLARATION
I hereby affirm that I,am licensed under Provislans of�C_P"af�r 9.(commencing with Section
7M, of Division 3 of the e9s,antSI4N6fessions,CJ ,and my license is in full force and
7B'
dr
effect.
- 7 -, -ir - -
5
SIGNATURE DATE
OWNER -BUILDER DECLARATION
I hereby I from for
Estimated. Valuation 41".500 00
affirm that am exempt the Contractor's License Law the'following
reason: (Sec. -7031.5,Sustness.and Professions P006: Any city -:m 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
PERMIT AMOUNT
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; tie. is exempt therefrom; and the. basis
for the Any Section. 7031.5.,by 'any for
Plan Chk. Dep.,
alleged exemption. violation of applicant a permit
subjects the applicant to'a civil penalty of not more than five hundred dollars ($500).
Plan Chk. 1361.
0.1, 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 -Const.
-3-5 00
Professions 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,
Mech.
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
Electrical
.of proving that he did not build orbriprove for the purpose of sale.)
0A, as owner of the property, am exclusively contracting with licensed contractors to con-
Plumbing
struct the project. (Sea ,7044, Business and -Professions Code: The Contract&'s License Law
does not apply to an. owner.of property who builds or Improves thereon, and. who. contracts for
S.M. L:
such projects with'a c6niractor(s) Ikensed pursuant to the Contractor's License Law.)_
I .
Grading
0 1 am exempt under S ec B. &;P.C. for.th is reason
Driveway Enc.
Date Owner
Infrastructure
WORKERS? COMPENSATION DECLARATION
I'hereby affirm that I have a 6ertificate*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
'*U filed
Copy Is with the city.. 0 Certified copy. is hereby. furnished:
TOTAL 35.001
CERTIFICATE OF EXEMPTION FROM'
'REMARKS
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 performanceofthp work for which. this• permit is issued, I shall*not
=trliFerrson in any manner so'as to become subject to the Workers' Compensation
California. a.
Date Owner.
NOTICE TO APPLICANT: ff, after making- this Certificate of, Exemption -'you - should becc;me
-ZONE:
subject' to the Workers' Compensation provisions of the -Labor Code, you must forthwith
Comply with such Provisions or this Permit shall be deemed revoked.
—BY:
Minimum Setback Distances:
Front Setback from, Center Line
Rear.Setback from Rear'Pr ip. Line
WARNING: FAILURETO SECURE WORKERS'COMPENSATION COVERAGE ISUNLAWFUL,AND
'Side Street Setback f TOM, Center,Line
SHALL SUBJECT AN EMPLOYER TO' CRIMINAL PENALTIES' -AND -CIVIL FINES UP TO ONE-
// 11;� _N1
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
I
Side Setback from Property Line
ATTORNEY'S FEES.
This is a building permit when -properly filled out, signed and.validated, and:is-subject to
FINAL DATE —IN01PECTO
expiration it work thereunder is suspended for 180 days.
I certify that I have. read this application and state that the above information is,correct.
Issued b Date I-* P In,
y
I agree to comply with all cit y and county ordinances and. state laws relating. to building
.. . , � /,9
construction, and hereby authorize representatives •of this city to enter the above -.
96
..
mentioned property for inspection purposes . .
Validated by:
Signature of applicant Date,
Mailing Address
Nalidation:
City, State, Zip
_e
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBINV FEES
1ST FL. SO. FT. ® $
2ND FL. SO. FT.
POR. SO. FT. ®
GAR. SO. FT. ®
CAR P. SO. FT.
WALL SD. 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
FLOOR DRAIN
MECHANICAL FEES
HEATING (ROUGH)
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
DUCT WORK
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
HEATING (FINAL)
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
BOND BEAM
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ®1 Va c
SEWAGE DISPOSAL
LUMBER GR.
SO.FT.GAR ® 3/sc
HOUSE SEWER
FRAMING
FINAL INSP.
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEEMECH.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.
NAL INSP7",—j
FRAMING
FINAL INSP.
ROOFING
f
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION q
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIONATURESIINITIALS
GARDEN WALL FINAL
'