14960 (SIGN)s
� IIII
4-
P.O. BOX 1504
Building78-495 CALLE TAMPICO
Address 50-055-illfashington Ste. sN LA OUINTA, CALIFORNIA 92253
Owner Country Club Rails
Mailing
Address Sc'irt4a
CityZip
La Qui.a°t�a, CA 92253
Contractor
Signs bl SEirVic6s
Address
10980 Boatman -Ave..
St;anton., CA zip90680
Tel.
. 311--3898.
10761-8200
& Classif..' Cu -$5 :439828 I Lic. # 3543
Arch., Engr.,
Designer y
Address Tel.
City Zip State
Lic: #
='-LICENSED CONTRACTOR'S DECLARATION..-.
I hereby affirm that I am licenspiller pr6visions.of Chapter 9 (commencing `ith S* ction
7000) of Division 3:o1 the usme s an"d•Professio § Code, and m license is (i,nj �ull fo ce a d -
effect. ��..'�,_..� ..�"�y.•'' y -i !jJ
SIGNATURE ,"'..�1 I _t DATE
OWNEWBUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following -
reason: (Sec. 7031.5,Business and Professions Code: -Any city or 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 df not more than five hundred dollars.($500).
0 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
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 or completion, the owner -builder will have the - burden
of proving that he did not build or improve for the purpose of sale.)
O t, 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) licensed pursuant to the Contractor's License Law.)
• O 1 am exempt under Sec. ` B. & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION .
1 hereby_afflrm that I have a certificate of consent to self -insure, or a certificate of.
worker's ,Crompensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Pofcy o• Company '
opy is filed with the city, O Certified copy is hereby furnished.
No. 14960 -
BUILDING: -TYPE CONST. OCC: GRP. -
P. Number
Legal Description
Project Description
41 i Cables' iet sign V� '
Sq. Ft.
Size
No. No. Dw.
Stories - Units
rNew ❑ Add ❑
Alter ❑ Repair ❑ ' Demolition ❑
Estimated Valuation
$1,200.00
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
35.00
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
..
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 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.
Dale Owner
NOTICE TO APPLICANT: If, aftermaking 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. -Minimum Setback Distances:
Front Setback from /ee ter Line
Rear Setback from r . Line
WARNING: FAILURE TO SECURE WORKERS'.COMPENSATION COVERAGE IS UNLAWFUL, AND
Side Street Set / rom Ce r 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( / - Prop e - . u e
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND 4A
ATTORNEY'S FEES. FINAL DATE INSPE�
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. • Issued by: Dat. E It
I agree to comply with all city and county ordinances and state taws 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 Address Validation:
City; State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBIW FEES
IST FL. SO. FT. ® $
UNITS
SLAB GRADE
2ND FL. SO. FT.
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 FOUN'iAIN
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 ER(AUTO)(DISH)
APPLIANCE DRYER
F NAL INSP. �
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
I
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 I
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1% c
SEWAGE DISPOSAL
GAR. FIREWALL
SO.FT.GAR ® 3Ac
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 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 NAL INSP. �
FRAMING
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
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