14955 (SIGN)414 Q
����IN
P.O. BOX 1504 No. 14955
Address 50 921 Washington Site. ALA OU NTA, CALIFORNIA 92253
Owner tI'aqueria Grill
maning
Address Same r
.City Zip Tel. '
La Quintal .CA 1 52'53 5653--5844
Contractor
Sigx d & 5er4ide s
A d els
$ ' U!! roAtmah Ave.
citSt$nton, CA*
Zip 90680
State Lic.
& Classif.. C-45 439328
' Arch., Engr:,
Designer
Address
City
lZip
I hereby affirm
7000) of Divisiof
effect. "moi"'
LICENSED CONTRACTOWS,DECU
BUILDING: TYPE CONST. -OCC: GRP.
A.P. Number
Legal Description (3)
Project Description 4-14 Wal-1S'i'gns
®®
0761-8200
City -
Lic. # 3543 Sq. Ft. No..
No. Dw.
Size Stories Units
Tel.
State
Lic. #
of Chapter 9 (commenci
Code, and my license is
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
'OWNER -BUILDER DECLARATION . Estimated Valuation
I hereby affirm that I am exempt from the Contractors License Law for the following
reasgn: (Sec. 7031.5,Business and Professions Code: Any city or countywhichrequires,a
perml to construct, after, improve, demolish, or repair any structure, prior to its issuance also
requites the applicant for such'permit to file a. signed statement that he is. licensed pursuant to - PERMIT
the provisions o/ 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 Plan Chk. Dep.
subjects the applicant to a civil penalty of not more than five 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, Bulsness and CrorlSt.'
Prolessions. 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 Improve 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 contractors) pcensed 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 affirm that 1. 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 p d Company
Copy is filed with the city. ❑ Certified copy.is hereby furnished.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
$3rOOOa.
AMOUNT
54.)0 35s5Gi
CERTIFICATE OF EXEMPTION -FROM
WORKERS' COMPENSATION INSURANCE
REMARKS
(This section need not tie completed If the permit is for one hundred dollars (S100) valuation
-
' or less.)
I certify that in the performance of thg work for which this permit is issued,.l shall not
employ any person in•any manner.so as to'become subject to the Workers' Compensation
Laws of Cali ornia.
-
-'
Date Owner
NOTICE. TO APPLICANT. N, after making -this' Certificate of Exemption' you should become .
ZONE:
' BY:
subject td the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed d revoked. ..
Minimum Setback DlStal]CeS:� '
-
•
Front Setback from Center Line
•
Rear Setback from Rear Prop.
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND
Side Street Setback from C ne,
SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO. ONE
HUNDRED THOUSAND DOLLARS.($100.0(0),•IN ADDITION TO THE COST OF COMPENSATION,'
Side Setback from PfOpe 1 e
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND
A
ATTORNEY'S FEES.
This is a building -permit when properly filled out, signed and validated, and is subject to
FINAL DATE
A -
INSP. r�yOR
expiration if work thereunder is suspended for 180 days.
Q
. I certify, that I have read this application and'state that the above information is correct.
Issued by:
Date Permit rr
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:
V r
Signature of applicant Date
Mailfrig.Address
Validation:
City, State, -Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBINU FEES
1ST FL. SQ. FT. ® $
2ND FL. SQ. FT.
POR. SQ. FT. ®
GAR. SO, FT. ®
CAR P. SQ. FT.
WALL SO. FT. ®
SO. FT. ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
y
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN.
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
ROUGH PLUMB.
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
GAS (ROUGH)
LAUNDRY TRAY
AIR HANDLING UNIT CFM
HEATING (FINAL)
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
1 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
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID 0 11/4 c
SEWAGE DISPOSAL
LUMBER GR.
SQ.FT.GAR ® V4c
HOUSE SEWER
FINAL INSP.
ROOFING
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEECONST.
FEE ELECT. FEE
SMI FEE PLUMB. FEE
i
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.
/
( FINAL IN "/ S
!!!
FRAMING
FINAL INSP.
ROOFING
F .
_
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL