14943 (BLCK)No. 14943
P.O. BOX 1504
Building 78-495 CALLE TAMPICO
Address 53-245 Eisenhower Dr. LA QUINTA, CALIFORNIA 92253
Owner Jose A. Munoz
Mailing BUILDING: TYPE CONST. OCC. GRP.
Address Saine
A.P. Number
City ip Tel.
Ir�..Quinta, CAT92253 Legal Description
ContractorProject Description 38' of ,4' high wood frame/
Owner/ftilder stucco fence
Address
City Zip Tel.:
State Lic. City
& Classif. 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
of fact.
1
SIGNATURE DATE
OWNEWBUILDER DECLARATION , �LJ
I hereby affirm that I am exempt from the Contractor's License Law for the following Estimated Valuation O00•0
reason: (Sec. 7031.5,Busl7ess and Professions Code: Any city or. county which requires a
permit to construct, after, Improve, demo!lsh, 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 that. he 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.
subiects.the applicant to a civil penalty of not more than rive hundred dollars ($500).
®'ll as owner of the property, or my employees with wages as their sole compensation, will Plan Chk. Bal.
do the work, and the structure is not Intended or offered for sale. (Sec. 7044, Buisness and Const. 15.00
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 of sale.) -
O 1, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing
strucl 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.I.
such projects with a contractors) jrcensed pursuant to the Contractor's License Law.)
Grading
❑ 1 am exempt under Sec B. & P.C. for this reason
Driveway Enc.
Date ��jZ7'9 owner x-��. Infrastructure
�r
t
WORKE S' 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.
TOTAL u5 . 00
CERTIFICATE OF EXEMPTION FROM REMARKS
WORKERS' COMPENSATION INSURANCE
(This section need not be completed H the permit is for one hundred dollars ($100) valuation
or less.) _
I certify that in the performance of thQ work for which this permit is issued, I shall not
employ any Person in any manrier'so as to become s�t•to the Workers' Compensation
Laws of ¢allfgrnia� \ Y�7
Date ,-Z f Owner
NOTICE TO APPLICANT: if, after making this Certifirovisions ofcate theofi emption you should become ZONE: BY:
comply with suchprovisro soorrNhisp Aitshatibn allbedeemedrevoked.�J Code, you must forthwith _Minimum Setback Distances: /
Front Setback from Center Lirf�
Rear Setback from, RearPne
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND Side Street SetbaCl(.fTOm Cent r Lin
SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE
iHUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, Side Setback from P&erty Li
DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOR CODE, INTEREST, AND
ATTORNEY'S FEES.
This isabuildin .FINAL DATE INSP
g permit when property filled out, signed 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. Issued by: Date it
I agree to comply with all city and county ordinances and state laws relating to building
i construction, and hereby authorize representatives -of this city to enter the, above-.
tion
mened property for inspection purposes. Validated by:
Signature of applicant Date
... Mailing Address Validation:
City, State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBINU FEES
1ST FL. SO. FT. ® $
UNITS
SLAB GRADE
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM m
2ND FL. SQ. FT. ®
FORMS
.•
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
FOR. SQ. FT. ®
GAS (ROUGH)
METER LOOP
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
GAS (FINAL)
.TEMP. POLE
DRAINAGE PIPING
CAR P. SQ. 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
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L 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, TEMIPERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SO. FT. ® c
BATH TUB
�J
LATHING
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 1'A c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/•c
I
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
E
i 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 �� 9�
FINAL INSP.
ROOFING
�/
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G
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
�J
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL <14-1194
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL
C
i
G/47
TV w.a y
x.
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CITY OF LA QUANTA
r:ti;-E -Y DEPARTMENT
"TIN,
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