14414 (PLBG)P.O. BOX 1504
Building 53-180 Ave. Valle o78-495 CALLE TAMPICO
Address LA QUINTA, CALIFORNIA 92253
Owner Mr. & Mrs. ar' teven' Godeel
Mailing S8il3e
Address
Cita Qginta, CA 92253
'166Wber Engineering & Construction I
Address .
58-175 Berros Court.
CityCati�edrai Ci.'vp, CA 922
State Lic.
& Classif.. A B 684563
Arch., Engr.;
Designer
C1619)#9111;-1120
City
Lic. #
Address Tel.
City Zip State
. Lic. If
1
I her affirm that I am lice under prc'vlsio s�f apter 9 (commencing with
000)oof Msiond3¢of the Busingss and Pro 6S iOr .ode and my license is inrfull fe
OWNER -BUILDER DECLARATION
I hereby affirmat 1 am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Susiness and Professions Code:. Any city or. county which requires a
permit to construct, after, Improve, demolish; or repair any structure,- prior to its issuance also
.,requires the applicant for such pemrft to rile a signed statement that he, is licensed pursuant to
the provisions of the Contractors 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 rive hundred dollars ($500). -
❑ I, as owner of theproperty, or. my employees with wages as their sole compensation, will
do the work, and the structure isnot 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 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 contractor(s) [rcensed 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 Compensation Insurance, or,a certified copy thereof. (Sec. 3800, Labor Code.)
.C."Polic o. company
Iff Copy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed H the permit Is for one hundred dollars ($100) valuation
orless.) '
I certify that in the performance of the work for,which this permit is issued, I shall not
employ
any
eon in any manner so -as to become subject to the Workers' Compensation
Laws of California
Date Owner
NOTICE TO APPLICANT: IF, , after making this' Certificate or Exemption you should* become
subject to the Workers' Compansabon 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 property filled out, signed and validated, and.is subject to
expiration if work thereunder is suspended for 160 days.
I certify that I have read this application and state that the above information is correct.
I agree to comply with all. cityand 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. 14414
WILDING: TYPE CONST: OCC: GRP.
k.P. Number
-egal Description
Sewer -Connect
)roject Description.
ZONE:
BY:
Minimum Setback
Distances:
Front Setback from Center Line
Sq. Ft.
Size • •
No.
Stories
No. Dw.
Units
New 11 Add ❑ -
. Alter 0
Repair ❑ Demolition O
FINAL DATE
INSPECTOR
Issued by:
Date �Pe�mit" .h
I III
Validated by:
Estimated Valuation
,� • �{)
PERMIT
1 l
AMOUNT
Plan Chk: Dep.
V,
Plan Chk. Bal.
Const.
Mech.
Electrical
'
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
j • U0
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 �Pe�mit" .h
I III
Validated by:
Validation:
1 l
V,
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBIW FEES
1ST FL. SQ. FT. ® $
UNITS
SLAB GRADE
2 ND FL. SO. FT. p
BONDING
YARD SPKLR SYSTEM
HEATING (ROUGH)
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
ROUGH WIRING
DUCT WORK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
METER LOOP
DRAINAGE PIPING
CAR P. I SQ. FT.
REINF. STEEL
GAS (FINAL)
WALL SQ. FT. ®
DRINKING FOUNTAIN
SQ. FT. ®
GROUT
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
BOND BEAM
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
FRAMING
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
ROOFING
LAUNDRY TRAY
AIR HANDLING UNIT CFM
REMARKS:
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
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1'A c
SEWAGE DISPOSAL
SQ.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
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 APP.IEQUIP.
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
� n
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIONATURESIINITIALS
GARDEN WALL FINAL