14300 (BLCK)Building 51-255 Ave. Her
Address
Owner 'Heriberto Pierre
j +iia'_-.�1"i°�I►{�!'�rAQ
P.O. BOX 1504 '
Y
era 78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253'
ra
t
Mailing 5c' me
Address
La Qu3.•nta�, CA zlp X22.53 T.
Contractor
owner/Builder
City 1 5 Zip Tel.:
s
State Lic. City
& Classif. Lic. #
Arch., Engr.,
Designer
Address I Tel.
City I
Zip I
State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of the Business and Professions Code, and my license is in full force and
effect.
SIGNATURE _ .DATE
OWNER -BUILDER 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 constiuct, alter, improve, demolish, or repair any structure, prior to its issuance also
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
for the alleged exemption. Any violation of Section 7031.5 by 'any applicant for a permit
sub,' Is the applicant to a civil penalty of not more than five hundred dollars ($500).
s_owner of the property, or my employees with wages as their sole compensation, will
do he 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 improve for the purpose of sale.)
O I, as owner of the property, am exclusively contracting with licensed contractors to con-
struct the project. (Sec. 7044, BusinesS.Ad 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 contractor(s) licensed pursuant to the Contractor's License Law.)
I am exempt under Sec. B. & P.C. for thisreason
to 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. Company
D Copy 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 person in any manner so a o, become subject to the WoNeW Compensation
Laws of California.-
Date
alifornia f// % `. t f ,✓'f f;
Date %r•, y'r Gj&ner - /! A7 is ; �1
N ICE TO APPLICANT: ff, affir making this Certificate of Exemption you should become
sect to the Workers' Compensation provisions of the Labor Code, you must forthwith
1160--ply
with such provisions or Nis permit shall be deemed revoked.
I
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 out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days.
I certify that 1 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
r
No. 1430 CO. t
BUILDING: TYPE CONST. OCC. GRP.
A.P. Number
Legal Description
- 136' of 6' high block wall
Project Description
15' of 5' high block Full
vi
Sq. Ft. No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
r
Estimated Valuation >3, .
PERMIT AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const. •
Mech.
Electrical '
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
i
TOTAL
REMARKS
ZONE:
BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE
INSPECTOR
Issued by:
Date
er
Validated by:
l"InIl A-0— 1004
i r,
ss
7
Validation:
I
/�
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBINU FEES
1ST FL.. SQ. FT.® Y ,`I
UNITS
COLL. AREA
SLAB GRADE
YARD,SPKLR SYSTEi A '
2ND FL SO. FT.
HEATING (ROUGH)
STORAGE TANK
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
FOUND. REINF.,
DRAINAGE PIPING
CAR P. SO. FT. ®
HEATING (FINAL)
OTHER APPJEOUIP.
WALT. SO. FT. ®
DRINKING FOUNTAIN.
,
SO. FT. ®
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
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
FINAL INSP.
LAUNDRYTRAY
AIR HANDLING UNIT CFM
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 ® i1/. c
SEWAGE DISPOSAL
Y
SO.FT.GAR g 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 t
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.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
G/ `
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I
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REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALLr/,
LATHING
MESH
INSULATION/SOUND
^
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL