14280 (BLCK)rt
Building"+
Address
C'wner
Mailing
Address
City
A 4
• ''�
P.O. BOX 1504 ` r
51�-595V� • HerreraLA
CALLE TAMPICO
LA OUINTA, CALIFORNIA 92253
Ricardo Floret;
Same
Zip Tel
92253
Contractor I
owner/Builder
Address
Zip
State Lic. I City
& Classif. Lic. #
Arch., Engr.,
Designer
Address Tel.
City (Zip (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 construct, after, improve, demolish, or repair any structure, prior 10 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 of not more than five hundred dollars (5500).
,.WOner of the property, or my employees with wages as their sole compensation, will
work, and the structure i5 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.) .
u 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 contraclor(s) licensed pursuant to the Contractor's License Law.)
Iam exempt under Sec. /� f B� P.C. for this reason
ate Owner
t-
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. 38.00, Labor Code.)
Policy No. Company
_. Copy is filed with the city. Q 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 as -to become subject tothe Workers' Compensation
Laws of California
Date Owner
AOTICE TO APPLICANT: If, after making this Certificate i,of Exemption �you should become
biect to the Workers' Compensation provisions of the Labor Code, you must forthwith
mply 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,DDo), 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 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 Dale
Mailing Address
City, State, Zip
No. 1 G• 2 ',,-Q.O
BUILDING: TYPE CONST. OCC. GRP.
A.P. Number
Legal Description
23' of 6' high block wWl
Project Description
REMARKS
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
ear S ack Rear Prop. Line
e Stet Sck from Center Line
' Side�Setb ck Property Line
FINAL nhTE_W1L'_2�1 l 4 SPECTOR
�..� <
Issued b� -Date
> Validated by: -
Q e is
Validation:
1
It
Sq. Ft.
Size
No.
Stories
No. Dw.
Units
New O Add ❑
Alter O
Repair ❑ Demolition 0
f
Estimated Valuation
$575.00
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
„
Const.
1 • v
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
n
TOTAL
�'` • v
REMARKS
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
ear S ack Rear Prop. Line
e Stet Sck from Center Line
' Side�Setb ck Property Line
FINAL nhTE_W1L'_2�1 l 4 SPECTOR
�..� <
Issued b� -Date
> Validated by: -
Q e is
Validation:
1
It
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBINU FEES
1ST FL. SO. FT. ® $
UNITS
COLL. AREA
2ND FL. SO. FT.
ROUGH PLUMB.
YARD SPKLR SYSTEM
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK ¢
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
DUCT WORK
DRAINAGE PIPING
CAR P. I SO. FT. ®
GAS (ROUGH)
METER LOOP
WALL SO. FT. ®
HEATING (FINAL)
DRINKING FOUNTAIN
SO. FT. ®
GAS (FINAL)
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
WATER HEATER
FLOOR DRAIN
MECHANICAL FEES
FINAL INSP.
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GRADING
cu. yd.
$ plus x$
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, TEMIPEFIM
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 ® 1 V. c
SEWAGE DISPOSAL
SO.FT.GAR @ 3/.c
HOUSE SEWER
GAR. FIREWALL
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 �t
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
FINAL INSP.
r
FRAMING
FINAL INSP.
ROOFING
///-2 � �
Atov
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE '
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES11NITIALS
GARDEN WALL FINAL
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