14853 (ELEC)4
ilding
e4
P.O. BOX 1504'
78-495 CALLE TAMPICO .
44-770 - N. Harland Dr. LA QUINTA, CALIFORNIA 92253
Stacy a Tom MacMillan
Address Same
City
La Quints, rA
Contractor
Owner'/Builder
Address
State Lic.
& Classif. ,
Arch., Engr.,
-Designer
Address
Zip Tel.
92253
LIC. #
City Zip State
I I Lic. #
LICENSED.CONTRACTOR'S DECLARATION
I hereby affirm that.1 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.
JIGaNATURE DATE
OWNER -BUILDER DECLARATION'
I hereby affirm that 1 am exempt from the Contractors License Law for the following
_ reason:, (Sec. 7031.5,Be�sa and Professions Code: Any city or county whkh requires a
. pemrft to construct, after,, Improve, demolish, or repair any structure, prior to>As lsauarwo. aao
requires the applicant for such po ro IAs a sfatenoent that he Is licensed pursuant to
the Provisions of. the Contractor's Ucerrse Lew, Gwpter 9 (commencing web Section 7000) of
l)/visbn 3'of the Business and.•Piofeselons .Code, or that. he is exempt therefrom, -and the basis.
for the alleged exerriptlon., Any violation of Section 7031.5 by 'any tippDcarut for a permit
subjects,llie appAcanf td a'cMpenalty of not more. than A►e hundred do0ers�(5500).. -
dB�; as owner of. the property, or my employees with wages asAheir sole compensation ; will
ddthe work, and the structure Isnot intended or offered for sale. (Sec..- 7044, Bu/anesa and
Professions Code: The Contractors License Law does not apply to an owner.of Property who
bunds or NMIoves thereon and who does such rank hbrrsell or through his own employees,
provided that such hnprovements,.are not intended or offered for safe. M, however, the buidng
or hVrovement.Is sold waft one year of completion,- the ownsr-0rJder wN here the burden
- of proving that he did not broad or, improve for the purpose of sale.)
❑ I, as owner oUthe property, am exclustvey contracting with licensed contractors to con-
struct the project (Sec. 7014; Business'ard.Proresslmrs 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 wfth-a contractors) licensed pursuant to the Contractor's License Law.) .
❑.I am exempt under Sec_ R g P.C. f this reason
to _ Owner '
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self -insure; ora certificate of
Workers Compensation Insurance, or a certified copy thereof. (Sec. 3600, tabor Code.)
PoliayNo. Company
❑ Copy Is filed with the city. _ ❑ Certified copy Is. hereby furnished.
CERTIFICATE OF EXEMPTION FROM
-WORKERS'COMPENSATIONINSURANCE
(This sectionneed not be 'cevrpleted h Me, pomdt is for one hundred dollars (t 100) vaknow
01 or less.) . ' - - I .
I certify that In the performance of the work which -this permit Is Issued, I shell not
employ arty Mon in:any man rso ea tosubject to'the'Workers' 'Compensation
pates�,Owner
NOTICE TO APPLICANT. M, afterrrwiirp ' Certl9cate, of Exonpflon' you shouts become
subject to the Workers' CwipenaaCon of the Labor .Code, you must forthwith
comply with such provisions or Mb, Pam* 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 s building permit when properly;filled'out, sighed 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 Inws 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 Add
City, state, zin
N0.14853
NG: TYPE CONST. OCC: GRP.
\:P. Number
_egal Description
11roject Description Install garage xloureacent
lighting
ZONE: BY:
,Minimum Setback Distances:
Front Se M11o Center Line
ac k Rear Pre
e Str t Set from Center Line
Tr Sl a Setbacl�fr operty Line
FI
Issued b / Dae Permit
Validated 'bVl
Validation:
Sq Ft.
Size
No.
Stories
No. Dw.
Units
New ❑ Add ❑
Alter ❑
Repair ❑ -Demolition ❑
Estimated Valuation
$100.00
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
15.00
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
15.00 .
REMARKS
ZONE: BY:
,Minimum Setback Distances:
Front Se M11o Center Line
ac k Rear Pre
e Str t Set from Center Line
Tr Sl a Setbacl�fr operty Line
FI
Issued b / Dae Permit
Validated 'bVl
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBINti FEES
IST FL. SO. FT. ® $
UNITS
SLAB GRADE
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL. SO. FT.
FORMS
)
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
CARP. SO. FT. @
GROUT
WATER HEATER
WALL SO. FT.
FINAL INSP.
DRINKINGFOUNTAIN.
FT ®
WATER SYSTEM
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
LAUNDRY TRAY
AIR HANDLING UNIT CFM
FIRE ZONE ROOFING
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.
SO. FT. ® c
BATH TUB
LATHING
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1'A c
SEWAGE DISPOSAL
SO:FT.GAR ® 3ic
HOUSE SEWER
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
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
_$
LUMBER GR.
FINAL INSP. '
FRAMING
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIONATURESIINITIALS
GARDEN WALL FINAL
OTALk C5 t0+4
Dom -