14754 (SATT)I`T}
Building
Address
Owner
4 4v Qum&
M
P.O. BOX 1504
78-495 CALLE TAMPICO
43-614 Calle Esperaaza LA QUINTA, CALIFORNIA 92253
h Associates
Mailin
Address 41-865 Boardwalk #212
City - Zip Ile,.
Palm Deserti, C _ 92213 (619)777-7766
Contractor
Same
Address
ty
State Lic. City
& Classif. B 4188234 Lic. # 1858
Arch.,'Engr.,
Designer Carlos Elias _ E»g$neer •
AjgCharl:e€mo_th Dr. (619)328-7271e
CityZip State
Cathedral City . CA 92234 Lic. #
LICENSED CONTRACTOR'S DECLARATION.
I hereby affirriilthat 1 am licensed under p ovlsion df Chapterg9 (commenci with Section
X000) of Diyvlsidn 3 of3the�Busi ass an//yy rofess�i jns�Code, a�H /m�ylic�ense is n
full
force and
SIGNATURE DATE
' OWNER•BUILDER DECLARATION I .
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, alter, Improve, demolish, or repair any structure,- prior to its issuance also
I requires the applicant for such permit to rile 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.
lot 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 rive hundred dollars ($500).
❑ 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 of completion, the owner -builder will have the burden
of proving that he did not build or knprove 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 andProfessions Code: The Contractor's License Law
does not apply to an,owner or property who builds or improves thereon, and who contracts for
such projects with a contractor(s) flcensed pursuant to the Contractor's License Law.)
❑ I 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.) .
Policy No.+'r Company
ly is filed with the city; ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
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 parson in any manner so as to become subject to the Workers'Compensation
laws of California
Date -Owner
Owner
NOTICE TO APPLICANT: N,_ after making this Certificate or Exemption you should become
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shalt 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 property 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 "
No. 14754
JILDING: TYPE CONST. VN OCC. GRP. R3
P. Number 646-121--021
gal Description Loi' 21 Tract 20052-4
Project Description' - Plan 4
Laguna De Lia Paz.
Sq. Ft. 1562
Size
No.
Stories
No. Dw.
Units
New ❑ Add ❑
Alter ❑
Repair ❑ Demolition ❑
Estimated Valuation
$93015.00
PERMIT
AMOUNT
Plan Chk. Dep. .
Plan Chk. Bal.
518.25
Const.
612.50
Mech.
7 c
62.00
Electrical
127.25
Plumbing
150.00
S.M.I.
9.37
Grading
20.00
Driveway Enc.
e00
Infrastructure
2,108.59
TOTAL
3,607.96
REMARKS
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear%enLi
Side Street Setback f eSide Setback from
FINAL DATE �NSPE(3Tr,
Issued bv: Date y s
Validated by:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBINU FEES
1ST FL. SO. FT. ® $
UNITS
SLAB GRADEJq
IV
ROUGH PLUMB.BONDING
YARD SPKLR SYSTEM
2ND FL. SO. FT.
FORMS 1
SEWER Oik I ROUGH WIRING
MOBILEHOME SVC.
BAR SINK `
POR. SO. FT. ®
GAS (ROUGH) METER LOOP
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
GAS (FINAL) TEMP. POLE
DRAINAGE PIPING
CAR P. I SO. FT. ®
GROUT
WALL SQ. FT. ®
FINAL INSP.
DRINKING FOUNTAIN
SQ. FT. ®
URINAL
ESTIMATED CONSTRUCTION VALUATION $
=$
WATER PIPING
NOTE: Not to be used as property tax valuation
FRAMING
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
FIRE ZONE ROOFING
LAUNDRY TRAY -
AIR HANDLING UNIT CFM
FIREPLACE
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
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 1114 c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/4c
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
CERT. OCC.
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEESMI
LELECT.FEEDBL
FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
GROUND PLUMBING UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADEJq
IV
ROUGH PLUMB.BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS 1
SEWER Oik I ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH) METER LOOP
HEATING (FINAL)
OTHER APP.IEQUIP.
REINF. STEEL
GAS (FINAL) TEMP. POLE
GROUT
WATER HEAT SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
VENTILATION
� /�� /J �J
C/ YA/SD
a
REMARKS:
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING 1
MESH
INSULATION/SOUND L�
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL