14859 (RC)4 4 QUA L
P.O. BOX 1504
Building 50-855 Fashingto.11 Ste. C. 78-495 CALLE TAMPICO
Address LA QUINTA, CALIFORNIA 92253.
Owner
ostal Connection
Zdr'es's same'
City Zip
La Qui CA 92253 Tel
it,
Contractor
"Stark'C6xistructio'n Cd. Inc.
Yd2S.r
V
5 Garahof, Std. E
9-i,fyha-De66kt','- COP 92261 - IT6
345 -9711 --
No. 14859
BUILDING: TYPE CONST.- OCC. GRP.—
A.P. Number
Legal Description
reiiant.4-
Project Description,, TMProvemen
State Lic. B City
& Classif.. 5-7776- '790
Lic. # Sq. Ft. No. No. Dw.
Size Stories Units
Arch., Endr., '
Designer - New 0 Add 0'- Alter 0 Repair 0 Demolition 0 -
Address TTel.
City ZIP State
I Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapler.9 (commencing with Section
I090) of Division 3 of the Business ,ailqr9fessions Code; and my license is in fulliforce'and -
Nect. - - -I - -
FSIGNATURE ✓ DATE
OWNER -BUILDER DECLARATION 7 *
I hereby affirm that I am exempt from the Contractor's License Law for the 'following Es
reason: (Sec. 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.
Division 3 of Business and Profession's Code, -or that. he, is exempt therefrom, and the basis
for the exemption. Any violation of Section 7031.5 by 'any applicant for a permit
subjects applicant to a civil penalty of not more than five hundred dollars (5500). .* . .
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, Buisn6ss and..
Professions Code: The Contractor's License Law does- not apply to an owner of property who
builds or improves thereon and whR, 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.)
0 1, 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 of property who builds or improves thereon, and who contracts -for
such projects with'a contractors) Vcensed pursuant to the Contractor's License Law.)
0 1 am exempt under Sec B. & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
timated Valuation $2,000.00
PERMIT-
AMOUNT
Plin,'Chk.'Dep.
Policy,No.- Company
Plldn-Chk. Bal.
29. u5
66fist.
45-.00
Mech.
Electrical
74J5
Plumbing
REMARKS
S.M.I.
n
Grading
PI
Driveway Enc.
Infrastructure
employ any personin any manner so as to' become subject to the Workers' Compensation
Laws of Cali 0 r me.
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
rbopy is filed with the city.. 0 Certified copy is hereby furnished. -
TOTAL
74J5
CERTIFICATE OF EXEMPTION FROM
REMARKS
• WORKERS' COMPENSATION INSURANCE
(This section need not be completed ff the permft.is for one hundred dollars ($100) valuation
PI
..or less.)
'I certify that in the performance of thp work for which this permit,is issued, I shall. not.
employ any personin any manner so as to' become subject to the Workers' Compensation
Laws of Cali 0 r me.
Date wrier70
NOTICE TO APPLICANT: If, after making'this Certificate of- Exemption -you should become
't6
ZONE:
BY'
subject the Workers' Compensation provisions of. the Labor Code, you. must forthwith
comply with such provisions or this permit shall be deemed revoked.
Minimum Setback Distances:
—Front Setback from Center Line
Rear Setback from Rear Prop. Line
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND
Side Street Setback from Center Line
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 Setback f rom.Property Line
DAMAGES AS PROVIDED FOR IN SECTION'3706 OF THE LABOR CODE, INTEREST, AND
ATTORNEYS FEES.
This is 6 buifding permit when properly filled out, -signed and validated, and is subject to z
FINAL DATE—
INSPECTOR
expiration it w=thereunder is suspended for 180 days..
I certify that I have read this application and state that, the above information is correct.
Issued by:
Date Permit
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.
Validated by:
Signature of applicant —Date. —
Mailing A - ddress
Validation:
City, State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBIW FEES
1ST FL. SQ. FT. ® $
UNITS
j
2ND FL. SO. FT.
YARD SPKLR SYSTEM
FOR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK r
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SO. FT.
`
DRAINAGE PIPING
WALL SQ. FT. ®'
DRINKING FOUNTAIN,
SO. FT. ®
HEATING (FINAL)
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
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
GRADING
cu. yd.
$ plus x$
LAUNDRY TRAY
AIR HANDLING UNIT CFM
IKITCHEN 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
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 1+/e c
SEWAGE DISPOSAL
FIREPLACE
SO.FT.GAR ® 3/ac
HOUSE SEWER
'
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.
INSP. ��
/FINAL
JLT?'� FRAMING' S
AL IN
ROOFING
K
REMARKS:
VENTILATION
FIRE ZONE ROOFING '
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
NAL INSPECTIO S
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
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