14724 (RPL)P.O. BOX 1504 No. 1$724
E3uilding 48-511 Viet Elzcanto r 78-495 CALLE TAMPICO
Address ( LA OUINTA, CALIFORNIA 92253
Owner scully,
Mailing BUILDING: -TYPE CONST: OCC: GRP.
Address Sne• A.P. Number
- . CityZip Tel.
7La Quin,�ta t -^A ..32253 564-6546. Legal Description
Contractor - Sia
caiiiffornia V6615" & Spas Project Description
Agle
0 BOcZft9alk A°'`i
city' Zip.Tel::
Paten Desert, A 9221 40-3009
State Lic. City
& Classif..;-5i568 Lic. # 3Sj Sq. Ft. No. No. Dw.
. ' Size Stories Units
Arch., Engr.,
Desigher New ❑ Add. ❑ . Alter ❑'. Repair ❑ -Demolition ❑
Address
Tel. -
CityZip
State
7. _..
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
000) of DivisloM3 of the Busines�sr�and Professions Code, and my license,ii, in full force aid
?DATE
DATE. >
SIGNATURE DATE—
'
OWNER -BUILDER DECLARATION.
I hereby affirm that 1 am exempt from the Contractors License Law for the following
reason: (Sec. 7031.5,Business and Professions Code:, Any city or county -which requires -a
Estimated Valuation
..
PERMIT
permit to construct. after, Improve, demofish, 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, Chapter9 (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 penalty of not more than rive hundred dollars ($500). • - . .
.❑ I, as owner of the property, or my employees with wages as their sole compensation, will.
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and
Professions Code: The Contractor's License Law does not apply to an. owner of property who
Plan Chk. Dep.
. .1
Plan Chk. Bal. r.,.
Const. - - '
Mech. •' -
builds or Improves thereon and who does such work himself or through his own employees,
provided that such Improvements are not Intended or offered for sale., If, however, the building
Electrical
• or improvement is sold within oneyear ol• completion, the owner -builder, will have the burden
of proving that he did not build or 'reprove for the purpose of sale.)
Plumbing
b I, as owner of the property, am exclusively contracting with licensed contractors to con-
struct the project. (Sec. 7044, Business and.Professions Code: The Contractor's License Law
does not apply to an owner or property who builds or improves thereon, and who contracts hr
such projects with a contractors) [incensed pursuant to the Contractor's License Law.) - -
O I am exempt under Sec. B. 8 P.C. for this reason
S.M:I.
Grading
Driveway Enc.
Date owner
Infrastructure
WORKERS' COMPENSATION DECLARATION
I here affirm that I have a certificate of consent. to self -Insure, ora certificate of
Worker' mpensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Poli No. Company
-
Copy is filed with the city, . ❑ Certified copy Is hereby,fumished. f
TOTAL
.t M-000.00.
AMOUNT
64.35
24.00
45.00
r 27.00
259.35
CERTIFICATE OF EXEMPTION FROM REMARKS.
WORKERS' COMPENSATION INSURANCE
(This section need not be completed If the permit is for one hundred dollars ($ f 00) valuation
'or less.)
1 certifythat in the t
performance of the 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 wR
NOTICE TOAPPLICANT. If, after making this Certificate of Exemption you should become ZONE: BY:
subject to the Workers' Compensation provisions of the Labor •Code, - you must forthw'lh
comply with such Provisions or this Permit shall be(learned rewked: Minimum Setback Distances: -
Front Setback 1romCenter Line
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 properly. filled out, signed and validated, and is subject to
expiration it 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
Rear Setback from Rear Prop: Line.
- Side Street Setback from Center Line -
Side Setback from Property Line /I
FINAL DATE INSPECTO/V
f sxm I SI
Issued by: Date_ �' mit I- I
Validated by: •',Q %
,
validation: `99c
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBIW FEES
IST FL. SO. FT. ® $
UNITS
COLL. AREA
2ND FL. S0. FT.
ROUGH PLUMB.
YARD SPKLR SYSTEM
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SO. FT.
DUCT WORK
DRAINAGE PIPING
WALL SO. FT.
GAS (ROUGH)
DRINKING FOUNTAIN
SO. FT. ®
HEATING (FINAL)
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GAS (FINAL)
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER HEATER
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
WATER SYSTEM
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
GRADING
-cu. yd.
$ plus x$
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
FIRE ZONE ROOFING
SO. FT. ®c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SPARK ARRESTOR
SO.FT.GAR ® 3/ic
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
r
MECH.FEE PL.CK.FEE
..
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING- " ' _ ELECTRICAL - , HEATING & AIR COND. SOLAR
t,,Ad
SETBACK
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC
VAK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP.IEOUIP.
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
�L
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL