14938 (DEMO)P.O. BOX 1504 No. 14938
Building 78-495 CALLE TAMPICO
Address 50-85S V aShin ton Ste. ; LA QUINTA, CALIFORNIA 92253
Owner
J,. Larry Fugate - BUILDING: TYPE CONST.. OCC: GRP.
Mailing
Address 208 S. Mamie Rd.
A.P. Number
City Zip Tel. —ZAP U
&tic t� r KS 67209 015 6n-9408 Legal Description
Contractor �rfrA . .%>raary demolition prior
41obYenz ' Con6truction Project Description
-Address . t® T.1.
33315 Victoria Construction
C•tY
.Zip T L'
R'Si Soret* CA (2530 T11 909)67917
State Lic. City _
& Classif. 1 5,22 s .. Lic. #�� Sq. Ft. No. No. Dw.
Arch., Engr.,Size Stories Units
•' •- . - _ .. _ - .. .
'Designer New ❑ Add ❑ - Alter ❑ Repair ❑ -Demolition p'.
Address Tel. ry
City Zip State
'Lic. #
LICENSED CONTRACTOR'S DECLARATION
)therebyy aff jm that,6 am licensed under provisions of Chapter 9 (commencing with Section
7000) 0,,ivision 3/of the;9uussirfdss and_Pro�fes+s`ions Code, -and my license is in full force and
ffectr stir �s�v
�LGNATURE ~ ./ DATE
OWNER -BUILDER DECLARATION" Estimated Valuation.
I hereby affirm that I am exempt from the Contractor's License Law for the following.
reason:. (sec. .703 1.5. Business and Professions Code: Any city -of couoty which requires a -
permit to construct, alter, Improve, demolish, or repair any structure, prior to its. issuance also
requires the applicant tor 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. he is exempt therefrom; and the basis.
for the alleged exemption. Any violation o/ section 7031.s by .'any •applicant for apermlt Plan Chk. Dep:
subjects rhe applicant to a civil penalty of not more than rive hundred dollars ($500): .. "
❑ I, as owner of the property, or my employees, with wages as their sole compensation, will Plan Chk. Bal.
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and Const. :�. ��
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; 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 - EIBCtfICal
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
strucl the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law
does not apply town owner of property:who builds or improves. thereon, and who contracts" for S.M.I. -
such projects with -a contractors)Vicensed pursuant to the Contractor's License. Law.)
Grading
❑ 1 am exempt under Sec B. & P.C. for this reason
Driveway Enc.
Date Owner Infrastructure
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I'Kave a certificate of consent to self -insure, or a certificate of
Worker's Co pensation Insurance, or a certified copy thereof. (Sec. 3800; Labor Code.)
Policy -Company "
qC opy is filed with the'city. ❑ Certified copy is hereby furnished.:
TOTAL 45.00
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 performance of the work for which this permit is issued, I shall not
employ anyperson In any. manner so as to become. subject to the' Workers' Compensation
Laws of California
Date � " • Owner
NOTICE TO APPLICANT: •ff, after making this Certificate of Exemption you 'should become ZONE: BY:
subject to the Workers' Compensation provisions of the 'Labor Code, you must forthwith '- -
comply with such provisions or this permit shall be deemed revoked. M Inlmu.m Setback Distances: -
Front Setback from Center Line
Rear Setback fro ear Prop. Line
WARNING: FAILURE TO SECURE WORKERS'COMPENSATIONCOVERAGE ISUNLAWFUL, AND
' SldcStreetSe fro Centerline
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.. Pro
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST,. AND
ATTORNEY'S FEES. i r
FINAL DATE II)�jPECTO
This Is a building permit when properly filled out; signed and validated, and is subject to.
expiration it work thereunder is suspended for 180 days. ry
I certify that I have read this application and state that the above information is.correct::' Issued by: ate Perml
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-. F
mentioned property for Inspection purposes.. Validated by: - '
Signature of applicantDate
Mailing Address . Validation:
City, State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBIW3 FEES
1ST FL. SQ. FT. ® $
2ND FL. SQ. FT.
POR. SO. FT. ®
GAR. SQ. FT. ®
CAR P. SQ. FT.
WALL SQ. 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.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APP.IEQUIP.
LAUNDRY TRAY
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.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/4c
HOUSE SEWER
REMARKS:
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.IEQUIP.
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