14606 (RPL)ti
Building
T-iht
P.O. BOX 1504
78-495 CALLE TAMPICO
54-050 Rise shower Dr. LA QUINTA, CALIFORNIA 92253
Owner Double D Construction
Mailing 51_960 Herrera
Address
City Zip Tel.
La Quintet, GA 92253 371-1561
Contractor
Same
Address
State Lic. g 681012(City 323
& Classif. Lic. #
Arch., Engr.,
Designer
Address—T—Tel.
City Zip State
I i Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under. provisions of Chapter 9 (commencing with Section
7000) of Division 3 �6ff th,�e,'Busine`ss and Professions_Code, gand my license is in full force and .
effect.i/ V `+�C` t _ ik ) t %}f{ fi'�
SIGNATURE i I TE
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 rile 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
subjects the applicant to a civil penally of not more than rive hundred dollars ($500).
❑ I, as owner of the property, or my employees with wages as their sole compensation, will
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
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.)
❑ 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.)
❑ 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.)
Policy No. Company
❑ Copy is filed with the city. O Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS'COMPENSATIONINSURANCE
(This section need not be completed it 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, I shall not
employ any person in any manner so as to become sugject to the Workers? Compensation
Laws I California % ' V `per �l, _,,, "_�'' L
Date 4 J f !~` `► Owner L/jjC'
NOTICE TO/APPLICANT: ti, after makfng 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.
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 it 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 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
ateMailing Address
City, State, Zip
BUILDING: TYPE CONST
A.P. Number
Legal Description
Project Description pia}'
No. 14606
OCC. GRP.:
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback fsom%enter Line
Side Setback from P,,r(fflprty Lme
FINAL DA
Issued by: Date �V ✓ errr
Validated by: eli +1
Validation:
Sq. Ft.
Size
No. No. Dw.
Stories Units
New ❑ Add ❑
Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
$7r500.00
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
68.35
Const.
99.00
Mech.
24.00
Electrical
45.00
Plumbing
27.00
S.M.I.
Grading
Driveway Enc.
Infrastructure
r.
TOTAL
259.35d
REMARKS
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback fsom%enter Line
Side Setback from P,,r(fflprty Lme
FINAL DA
Issued by: Date �V ✓ errr
Validated by: eli +1
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBINU FEES Kr,
4
1ST FL.SO. FT. ® $
UNITS
SLAB GRADE
+
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
STORAGE TANK
2ND FL. SO. FT. @
SEWER OR SEPTIC TANK
ROUGH WIRING DUCT WORK
ROCK STORAGE
MOBILEHOME SVC.
BAR SINK
GAS (ROUGH)
POR. SO. FT. ®
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
"�•
GROUT
DRAINAGE PIPING
WATER HEATER
CAR P. SO. FT.
FINAL INSP.
BOND BEAM
WALL SO. FT.
WATER SYSTEM
DRINKING FOUNTAIN
GRADING
cu. yd.
$ plus x$
_$
LUMBER GR.
URINAL
FRAMING
SO. FT. ®
ROOFING
ESTIMATED CONSTRUCTION VALUATION $
�
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
FIRE ZONE ROOFING
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
SPARK ARRESTOR
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
LATHING
AIR HANDLING UNIT CFM
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET'
INSULATIONISOUND
COMPRESSOR HP
POLE, TEMIPERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
FINAL INSPECTION
, tv
BOILER B.T.U.
SO. FT. ® c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1 1A c
SEWAGE DISPOSAL
'
SO.FT.GAR ® V4c
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 PLUMBI
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
FINAL INSP.
GRADING
cu. yd.
$ plus x$
_$
LUMBER GR.
FRAMING
FINAL INSP.
ROOFING
�
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
, tv
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESlINITIALS
'
GARDEN WALL FINAL
CC."sD'ITIONALLY
AMEPTED '(--043 C0NIS'F,SUCTION
%r3L; L& jEC T A 1 1. A.'T C) ' AS P E R
AND ALL APPLICABLE COPES
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14115 K=W
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