15622 (RPL)J'
l.�
9
Building',
Address
Owner David Weintraub
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Mailing
Address Same
City
Zip
Tel.
La QuLnta, CAI
92253
Contractor
Steve' Dodson
Address
68-905, Perez Road
cta-thedral Clys
p CA 92234
re1.324-1232.
State Lic.
City
& Classif. 579127
Lic. # 1044
'Arch:, Engr.,
Designer
Address
Tel.
r
City I Zip I State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under Provisions of Chapter 9 (commenc'ng with Section
7�W) of Diivisidn 3 of the Business and Professions Code, andemy license is n full force and
fect
SIGNATUR- DATE
OWNEWBUILDER DECLARATION
I hereby affirm that I am exempt from the Contractors 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
W.- requires the applicant for such permit to rite a signed statement that he is licensed pursuant to
the provisions or 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).
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 t
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 wfthln one year or completion, the owner -builder will have the burden
of proving that he did not build or knprove for the purpose of sale.) '
O 1, 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) #tensed 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 Cofnpensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)'
PolfcY N . Company
yup is filed with the city, ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed N the permit is for one hundred dollars ($100) valuation.
or less.)
I certify that in the performance of th0 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: N, after, making this Certificate of Exemption you 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 but, 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_
ity to enter the above-..
mentloned property for inspection purposes.
Signature of applicant Date
- Mailing Address
City, State, Zip
No. 15522
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number
(Legal Description
Project Description Pool and Spy:
Sq. Ft. No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
.r
t
Estimated Valuation $120000.00
PERMIT AMOUNT
Plan Chk. Dep.
Plan Chk. Bal. �r $7.75
Const. 135.00
Mech. 24.00
Electrical- 4S -nn
Plumbing 27.00
S.M.I:
Grading )
Driveway Enc.,
Infrastructure
TOTAL 318.75
REMARKS
ZONE: BY:
Minimum Setback Distances:
Front Setback from CentteejLlne
Rear Setback from ri9PAi�e
tb c
Side'Street Se,f`to Center L• Ine
Side, Setback�f om Property Linn. e�
r �
FINAL DATE INSPECT,QR �/
Issued by: Date\ Permit
Validated by: <R0
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBIW FEES t
1ST FL. SO. FT. @ $
2ND FL. SO. FT. @
POR. SO. FT. @
GAR. SO. FT. @
CAR P. S0. FT. @
WALL S0. FT. @
SO. FT. @
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTEM ;.
tt--
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
STORAGE TANK
FLOOR DRAIN
MECHANICAL FEES
DUCT WORK
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
REINF. STEEL
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
FINAL INSP.
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.
SO. FT. RESID @ I'A c
SEWAGE DISPOSAL
SO.FT.GAR @ 3/ac
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
J
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
GROUND PLUMBING /, 9 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) A' METER LOOP
O
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
GAS (FINAL) TEMP. POLE
GROUT
WATER HEATER SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM �O /� �Ii/9
FINAL INSP.
FINAL INSP.
GRADING.
cu. yd.
$ plus x$
_$
LUMBER GR.
FRAMING
ROOFING
_ '
��f L.—
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION G�
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL