14956 (SIGN)P.O. BOX 1504
Building 78-495 CALLE TAMPICO -
Address 50-85�. WashAington .Sty:. i�4,LA OUINTA, CALIFORNIA 92253
Owner
No. 14955
owul VA. ASIZ
Mailing �, ..
BUILDING? TYPE CONST. OCC: GRP.
Address Same
City Zip
La Quinta, - CA 92.253
Contractor
14—a5 & sE'X\/3
S -14 -as
Ad ress ..
1fJ SSU Bdatmifi JAV6.
City Zip
Sia ` CA 90680
�aa,
State Lic.
& Classif.. tom- 45' 43395.28
'Arch.,-Engr.,
Designer
Address
City IZip
LICENSED COI
I hereby affirm that I am licensed and
7000) of Division 3 of 11456�ine ss.and'
effect. ✓'��
8'64--3809
Tel'
City
Lic. # 3.543
Tel.
State
Lic. #
and my license is
OWNER -BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractor's License Law. for the following
reason: "(Sec. 7031.5,Buslness and Professions Code: Any cityor county* which requires •a
permit to construct, atter, .improve, demolish, or repair any structure, prior to its issuance. also
requires the applicant for such permit 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 by ,'any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars ($500). I •
❑ 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
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 onprove for the purpose of sale.)' .
❑ 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 of property who builds or improves thereon, and who contracts for
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec. B. & P.C. for this reason
Date Owner
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.)
Poi pany
lYCopy is filed with the.city. ❑ Certified.copy is, hereby furnished:
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
. (This section need, not be completed H 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 any person in any manner so as to become subject to the Workers' Compensation
Laws of California.
Date Owner
NOTICE -TO APPLICANT; It, alter making this Certificate of Exemptionyou 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.
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,
DAMAGES AS PROVIDED FOR IN SECTION 3706.OF THE'LABOR CODE, INTEREST, AND
ATTORNEY'S -FEES.
This is a building permit when properly filled out, signed and validated, and is subject to
expiration if work.thereunder is suspended for 180 days.
_ I 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.-.
Signature of applicant Date
Mailing Address
City, State, Zip
A.P. Number
Legal Description .
Project Description 41' :all.- ukQn
'Sq. Ft. No. No. Dw.
Size Stories....Units.
New ❑ Add ❑ Alter ❑'� Repair ❑ -Demolition 0.
Estimated Valuation $,J`0 200 0 00
PERMIT AMOUNT
Plan Chk.'Dep.
Plan Chk. Bal.
..Const..
Mech.
'Electrical5,0
Plumbing
Grading
Driveway;Enc. •y
Infrastructure
35.
TOTAL
REMARKS
ZONE: BY:
Minimum Setback Distances:
Front Setback fird/nter eRear.Setbac � fr° e
Side Street ackr�om Ca t r L e
Side Setba . from Party•L1 e
FINAL DATE INSPECT , ~
Issued by- D to Pdr(ppit -
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBIW FEES
1ST FL. SO. FT. ® $
2ND FL. SQ. FT. ®'
POR. SO. FT. ®
GAR. SO. FT. ®
CAR P. SQ. 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
ROUGH PLU _`--jr
FLOOR DRAIN
MECHANICAL FEES
HEATING (ROUGH)
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
DUCT WORK
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
(ROUGH) /�{may
L
LAUNDRYTRAY
AIR HANDLING UNIT CFM
HEATING (FINAL)
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET'
COMPRESSOR HP
POLE, TEM/PERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SQ. FT. ® c
BATH TUB
BOND BEAM
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
LUMBER GR.
SQ.FT.GAR ® 3/ac
HOUSE SEWER
r-eFRAMING
FINAL INSP.
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 PLU _`--jr
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPPT�IC TANI(
^UGH WIRIN
IC
DUCT WORK
ROCK STORAGE
FOUND. REINF.
(ROUGH) /�{may
L
METER LOOP
HEATING (FINAL)
OTHER APP./EQUIP.
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. _
r-eFRAMING
FINAL INSP.
ROOFING
AcREMARKS:
S1,6q ��
�_
��%//•
VENTILATION
r
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIONATURESIINITIALS
GARDEN WALL FINAL