14959 (SIGN)4
P.O. BOX 1504 No. 14959
Building 78-495 CALLE TAMPICO
Address 50-855 Washington Ste. C LA QUINTA, CALIFORNIA 92253
Owner
Postal Connection
Mailing .:
Address 83611 E.- Evans Rd. Suite 112.
City
Zip
Tel.
Scottsdale,
8526E3
C6 2)
Contractor
Siqns a Services
Address -.
10980 Boat -man Ave.'
City
Stanton, CA
Zip .
90680
Te .:
+ 714) 761--8200
State Lic.
City
& Classif.. d-45 43982$
Lic. # .3543
Arch.; Engr.;
Designer
Address
Tel.
City Zip 'State
Lic. #
BUILDING-. TYPE CONST.' OCC: GRP.
A.P. Number
Legal Description
Project Description � � gall Sign
Sq. Ft. No. No. Dw.
Size Stories. • - Units
New ❑ Add ❑ -Alter ❑. Repair ❑ 'Demolition'❑
LICENSED CONTRACTOR'/R'S'DE LARATION
I hereby affirm that licensad under provisions o Chapter 9 (commencing wi 11 Se ion
7000) of Division the>Buainessand Profei Code,
.of and my license is in ulfoand'-y
effect /.�.-..0 -=
OWNER -BUILDER DECLARATION '
I hereby that I from the Contractors License Law for 4ollowing
Estimated .Valuation, @ [�[: a�An
$1,.20 a V
affirm am exempt the
reason:. .(Sec. 7031.5,Business and. Professions .Code: Any city or county which requires a
V .
+
permit to construct; alter, 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
PERMIT - AMOUNT '
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) or
-
Division 3 o% the Business and Professions Code, or that. he Is exempt therefrom, and the basis
for the' alleged Any Section 7031.5 by 'anyfor
Plan Chk., Dep.
exemption. violation of applicant a permit
subjects the applicant to a civil penalty of not more than five hundreddollars ($500). - .-
Plan Chk. Bal.
❑ I, 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.
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
Electrical -rj, 00
of proving. that he dill not build or improve for the purpose of sale.)
a
0•1, as owner of the property, am exclusively contracting with licensed contractors to con-
Plumbing
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
S.M.I. -
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
- -
Grading
❑ I am exempt under Sec B. 8 P.C. for this reason
Driveway Enc.
Date owner
Infrastructure
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.)
Po11CY140-- Company
'e'Copy
is filed with the city.. O Certified copy is hereby furnished.
TOTAL 35.00
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 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 ' • Owner
NOTICE TO APPLICANT: •d, after making this Certificate of Exemption you should become
'subject
•.'ZONE: BY:
to ire 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 I
Rear Setback from Rear�f Lire
WARNING: FAILURE TO SECURE WORKERS'COMPENSATIONCOVERAGE ISUNLAWFUL, AND
Side Street Setback fro n r Lin
SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES 'AND CIVIL FINES UP TO ONE.
HUNDRED THOUSAND DOLLARS IN -ADDITION TO THECOST
($100,000), OF-COMPENSATION,Slde
Setback from Pf erty In
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND
ATTORNEY'S FEES.
'This is a buildingFINAL
permit when properly filled out, signed and validated, and is subject to
DATE 'IN PECT +
n
expiration if work thereunder is suspended for 180 days.
/ fJ
I certify that I have read this application and state -that- the'above information is correct.
Issued by: Date ` ermtt
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-.
syn
mentioned property for Inspection purposes.
Validated by: -.
Signature of applicant Date
Mailing Address
Validation:
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
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO, FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SO. FT.
GAS (ROUGH) .
DRAINAGE PIPING
WALL SO. FT.
OTHER APPJEOUIP.
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.COOL HOOD
SIGN
WASH E R(AUTO)(DIS H)
APPLIANCE ' DRYER
F AL INS f—
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, TEM/PERM
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 ® 1 Va c
SEWAGE DISPOSAL
GAR. FIREWALL
SO.FT.GAR Q 3/ac
HOUSE SEWER
LATHING
GAS PIPING
PERMIT FEE
MESH
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 APPJEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
-
GRADING,
cu. yd.
$ plus x$
_
=$
LUMBER GR.
F AL INS f—
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 SIGNATURES/INITIALS
GARDEN WALL FINAL