14734 (RER)Build ng
Address
52-190 Eisenhower Dr.
P. Crawford Jr.
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Address 52-190 Eisenhower. Dr.
City Zip Tel. '
La Qninta 92253
Contractor
Owner/Builder
ress .
Same as above
State Lic.
City
& Classif..
Lic. #
I
-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 .
f effect.
$LGNATURE 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, alter, improve, demolish,or repair any structure, prior to 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 ,Profession 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). .
PSI, as owner of the property, or my employees with wages as their sole compensation, will
Qdrthe 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 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) licensed pursuant to the Contractor's License Law.)
rfi ,f
❑ f am exempt under Sec. FB. & P.C.'for thisyeaeason
Date ^!r7/�!`+r/JOwner
e •' . 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
❑ Copy is filed with the city, ❑ Certified copy is hereby furnished..
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed i! the permit Is for one, hundred dollars I'S 100) valuation
or less.) f ,,il: 1
I certify that in the performance of thg work for which this -permit is issued, l shall not
employ any ppersomin any manner so as to become" ub'ect to the Workers' Compensation
Laws of CalifornW,r�
Date . h a f+�/Owner r */ +!'off J % �%%I/ja
NOTICEfTO,APPLiCANT.. N, eReiFinaking this` gert�cate'olrExemptldn.Syou should become
subject° to the Workers' Compensation' provislons 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 (5100,000), 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 issubject 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 Date
Mailing ,Address
City, State, Zip
No. 14734
BUILDING: TYPE CONST. . - OCC: GRP.;
P. Number
Legal Description Exterior Garage. Door Addition
Project Description
Sq. Ft. No.
Size Stories
No. Dw.
Units
New ❑ Add ❑ Alter ❑ .
Repair ❑ Demolition ❑
Estimated Valuation
$500.00
t
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
' +'
Driveway Enc.
Infrastructure
TOTAL
15.00
REMARKS
ZONE: BY:
Minimum Setback Distances: r '
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 Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBIWU FEES
IST FL. SO. FT. ® $
UNITS
v
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL. SO. FT. @
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK A
POR. SO. FT.
GAS (ROUGH)
METER LOOP
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
GAS (FINAL)
TEMP. POLE
DRAINAGE PIPING
CAR P. I SO. FT. ®
GROUT
WATER HEATER
WALL SQ. 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
FINAL INSP.
WATER SOFTENER
VENT SYSTEM FAN EVAP,COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
REMARKS:
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
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
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/. c
SEWAGE DISPOSAL
MESH
SO.FT.GAR ® 3/ic
HOUSE SEWER
INSULATIONISOUND
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE EPL.CK.FIEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR GOND. 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
9
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 SIGNATURESIINITIALS
GARDEN WALL FINAL —::
GNI Mee,
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SU&JEC i TO INSTALLATION AS PER
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SU&JEC i TO INSTALLATION AS PER
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DATE //5�1�� BY 7414A�
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