15807 (BLCK)A' Q �
44Q
P.O. BOX 1504 NO. 15807 �
Building78-495 CALLE TAMPICO
Address 53-125 Eisenhower DriVe LA QUINTA, CALIFORNIA 92253
Owner '
Rafael. Munoz
Mailing BUILDING: TYPE CONST. OCC. GRP.
Address same as above
A.P. Number
City Zip Tel.
'Aria Quinta 92253 Legal Description
Contractor Project Description 401f of 4' wood frame o
Address -lath, and plaster wall.
City Zip Tel.:
State Lic. City
& Classif. %Lic. # Sq. Ft. No. No. Dw.
Arch., Engr.;
Size Stories Units
-
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) t. of Division 3 of the Business and Professions Code, and my license is in full force and
effec
$LGNATURE DATE
OWNER -BUILDER DECLARATION Estimated Valuation
I hereby affirm that 1 am exempt from the Contractor's License Law for the following 6,40.00
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 to its issuance also
requires the applicant for such permit to file a signed statement that he is licensed pursuant to PERMIT AMOUNT
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Division 3 of the Business and Professions Code, or thathe is exempt therefrom, and the basis -
for the alleged exemption. Any violation of Section 7031.5 by any applicant . for a permit Plan Chk. Dep.
subjects the applicant to a civil penalty of not more than five hundred dollars ($500).
XI, as owner of the property, or my employees with wages as their sole compensation, will Plan Chk. Bal.
.. the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and riOflSt. 2� ��
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, Mech.
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 Electrical
of proving that he did not build or Improve for the purpose or sale.)
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing
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 contractors) licensed pursuant to the Contractor's License Law.)
Grading
❑ 1 am exempt under Sec. B. & P.C. for this reason
Driveway Enc.
Date PI "2 'f/`r Ovaner r f_!,(tkr -,4.4 a-, 'ter Infrastructure
WORKERS' COMPENSATION DECLARATION
i 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 25.00
I CERTIFICATE OF EXEMPTION FROM REMARKS
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 thg work for which this permit is issued, I shall not
employ any person in any manner so as to become subject to the Workers' Compensation
Laws of California
Date Owner
NOTICE TO APPLICANT: N, after making this Certificate of -Exemption you should become ZONE: BY:
subject to the Workers' Compensa8on provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shah be deemed revoked. - Minimum Setback Distances:
Front Setback from Center Line
Rear Setback fr� f -R r Pr P. Line
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND Side Street.Se back from Center Line
SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE �t"� '�
HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, - Side Setback from Proper -t Eioe
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THELABORCODE, INTEREST, AND /
ATTORNEY'S FEES.V/
This is a building permit when properly filled out, signed and validated, and is.subject to FINAL DATE INSPECTOR
expiration if work thereunder is suspended for 180 days. s�
I certify that I have read this application and state that the above information is correct. Issued b -41. DatePer,
I agree to comply with all city and county ordinances and state laws relating to building y %
construction, and hereby authorize representatives -of this city, to enter the above-. t9
mentioned property for inspection purposes. Validated by: \ t9R yyy
Signature of applicant Date \ // T
Mailing Address Validation: \ /
City, State, Zip \
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBINU FEES
IST FL. SO. FT. ® $
UNITS
COLL. AREA
2ND FL. S0. FT. p
ROUGH PLUMB.
YARD SPKLR SYSTEM
BONDING
MOBILEHOME SVC.
BAR SINK
FOR. SO. FT. ®
SEWER OR SEPTIC TANK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
FOUND. REINF.
GAS (ROUGH)
DRAINAGE PIPING
CAR P. I SO. FT.
HEATING (FINAL)
OTHER APP./EOUIP.
WALL SO. FT.
GAS (FINAL)
DRINKING FOUNTAIN
SO. FT. ®
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER HEATER
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SYSTEM
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
FINAL INSP.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
I
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.
SO. FT. RESID ® 1 Va c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ac
HOUSE SEWER
LATHING 9
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./EOUIP.
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 tl?22/ �
FINAL INSP.
ROOFING
/ n ��1
/
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING 9
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION �(J / ,
CERT. OCC.
FENCE FINAL �d/8 (�r
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL