14651 (RER)P.O. BOX 1504 No. 146
Building 51—d r• Eise 3bOw@r 78-495 CALLE TAMPICO
Address LA QUINTA, CALIFORNIA 92253
Owner .Oscar B. AY1tezcua
manlny
Address.' P.O. BOX 110
CZip Tel.
itTe=al, .CA, 92274
Contractor
Address
11LDING: TYPE CONST. OCC. GRP..
P. Number
Description
iRoplaster hqi se '
City
Zip
Tel.:
State Lic. ;
City
& Classif. r .-
Lic. #
Sq. Ft.
No. No. Dw.
Size
Stories Units
Arch., Engr:,
Designer
New ❑ Add ❑;
Alter ❑ Repair ❑ Demolition ❑
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.
$LGNATURE DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractors License Law for the following
Estimated Valuation�J�
�} +
i reason: (Sec. 7031.5,Business and Professions Code: AnyTity•or county,,.which requires a '
PERMIT
AMOUNT
i permit to construct, alter. Improve, demolish, or repair any structure, prior to its issuance also
requires the applicant for such permit to Ole 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
s bjects the applicant to a civil penalty of not more than rive hundred dollars ($500). ..
` r 1, as owner of the property, or my employees with wages.as their sole compensation, will.
'� Plan Chk: Dep.
Plan Chk. Bal.
Const.
30.00
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
M@Ch:
I 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
Electrical
or improvement is sold within one year of completion, the owner -builder will have the burden
O proving that he did not build or inprove for the purpose of sale.)
' Plumbing
-
❑ 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
S.M.1.
-
such projects with a contractor(s) /icensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec. B. & P.C. for this reason
Grading
Driveway Enc.
*--te owner (-N, r' ' ' �+ �3 �"' '�. F.+
s
Infrastructure
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
O Copy is filed with the city, ❑ Certified copy is hereby furnished.
TOTAL
30.00
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
REMARKS
(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, 1 'shall not
employ any person in any manner so as to become subject to the Workers' Compensation
Laws of California., t"
Date .i� Owner �. f• rS j .�..�-. �xtr �.
f 71fOTICE TO APPLICANT: It. after making this Certificate of Exemption you should become
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
ZONE:' BY:
Minimum Setback Distances:
Front Setback from Center Line
I
Rear.Setback,from Rear Prop. Line
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND
SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE
Side Street Setback from Center Line
HUNDRED THOUSAND DOLLARS ($100,000)• IN ADDITION TO THE COST OF COMPENSATION, -
Side Setback from Property Line
DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOR CODE, INTEREST, AND
ATTORNEY'S FEES.
Ttils is a building permit when properly filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days.
FINAL DATE
INSPECTOR
I certify that I have read this application and state'that the above information•iscorrect.
I agree to comply with all city and county ordinances and state laws relating to.
o building
construction, and hereby authorize representatives -of this city to enter the above-.
mentioned property for inspection purposes.
Issued by:
Validated by:
Date Permit
•
Signature of applicant Date
Mailing Address
Validation:
City, State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBINU FEES
IST FL. SO. FT. ® $
UNITS
SLAB GRADE
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL. SO. FT.
FORMS
SEWER OR SEPTIC TANK
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. SO. FT.
GROUT
WATER HEATER
WALL SO. FT.
FINAL INSP.
DRINKING FOUNTAIN
SO. 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
VENTILATION
LAUNDRYTRAY
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 ® 3/<c
HOUSE SEWER
FINISH GRADING
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./EQUIP.
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
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIONATURESJINITIALS
GARDEN WALL FINAL