14619 (RC)4
P.O. BOX 1504 ' N o . 14 619
Building 78-495 CALLE TAMPICO
Address 50-855 Washin ton St • ;Jed LA QUINTA, CALIFORNIA 92253
Qrimer
Address 74-998 Country Club Dr. ;220
.CityZip Tel. -'
Palmi. Desert, C1 92211 .34.E-�3896
Contractor
Trask Confa triad n.
Address
12581 Trask Ave..
Garden Crone, �p 92643 TeI.(7349 537531
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number
Legal Description
Project Description Tenant. Improvement
.Country Club .gaily
State Lic.
City
& Classif..
Lic. #
Sq. Ft. No: No. Dw.
Size Stories > - Units
Arch:, Engr., .
Designer
New ❑ Add ❑ Alter_❑ Repair ❑ 'Demolition ❑
Address
Tel.
CityZip
State
_
Lic. #
LICENSED. CONTRACTOR'S DECLARATION'
I hereby affirm that I am.licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of the Business and Professions Code, and my license is In full force and,-
• effect':.t'f M'Gi><��fli jy+�err i��t'�rrF-
,
SIGNATURE -Y F DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's' License. Law for the following
reason: (Sec.,. 7031.5,Bustness 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,fiile a signed statement that he is licensed pursuant to
. the provisions of the Contractor's License Law, Chapter 9 (commencing with. Section 7000) of ' •-
Divlsion 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 five hundred dollars ($500)_ . -
0, I, as owner. of the property, or my, employees with wages as their sole compensation, wwillan
do the work, and the structure is not intended or offered for sale. (Sec. 7044; Buisness 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 or improve for the purpose of sale.): • -
❑ I, as' owner of the property, am exclusively contracting with. licensed contractors to con-
struet the project. (Sec: 7044, -Business and -Professions Coder 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 coniractor(s) #tensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec -B: & P.C. for this reason
Estimated ValUatlOn
; @f� V �' A ,
$ iv V• 0
.. -
..: •.PERMIT.. - AMOUNT
-
-
Plan Chk. Dep. "
Pl Chk. Bal. �a • 3
Co. 99..00
_
(}{
Mech. .00
Electrical - �.. V�
'
Plumbing 27.00
•S.M.I. - -
Grading
Driveway Enc.
Date Owner
Infrastructure
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have acertificate of consent to self -insure, or a certificate of
Worker'�#Company nce, or acerlified copy thereof. (Sec: 3800, Labor Code.)
Poliriy na Yy. ., O Certified copy is hereby furnished.
TOTAL 205.35
CERTIFICATE OF EXEMPTION FROM
- WORKERS' COMPENSATION INSURANCE
REMARKS
(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.
Date--1Owner.
. NOTICE TO APPLICANT: lf, ,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. •
—
ZONE: BY: '
Minimum Setback Distances: ..
Front Setback from :Center Line
•
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND
SHALL SUBJECT AN EMPLOYER .TO CRIMINAL PENALTIES AND CIVIL FINES. UP TO ONE '
Rear Setback from Rear Prop. LJna
Side Street Setback from CentIn
/e
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 es a building permit when properly filled out, signed and validated, and is subject.to
expiration it work thereunder is suspended for 180 days: .:
Side Setback from;Property'LI \
�t' rf t
FINAL. DATE INS,PE .TOR �U !
C< '9
I certify that 1 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
Maeling.Address
ISSUed by: ' Date `� Pel it.
,.�
Validated by:
f \ 9n
Validation: V
//
City, State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBIW FEES
1ST FL. SO. FT. ® $
UNITS
SLAB GRADE
2ND FL. SO. FT. p
BONDING
YARD SPKLR SYSTEM Y
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS L
CAR P. SO. FT.
GAS (ROUGH)
DRAINAGE PIPING
WALL SO. FT.
OTHER APPJEQUIP.
DRINKING FOUNTAIN
SO. FT. ®
TEMP. POLE
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GROUT
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SYSTEM
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(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,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
GAR. FIREWALL
SO.FT.GAR ® 3/ac
HOUSE SEWER
LATHING
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 APPJEQUIP.
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
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
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