14806 (BLCK)T4*
P.O. BOX 1504 No. 14806
Building ti7_515:
_5155 Via Florence-. 78-495 CALLE TAMPICO
Address LA QUINTA, CALIFORNIA 92253
Owner mannas Construction
Mailing BUILDING: TYPE CONST. OCC: GRP.
Address 154 .Desert. Fails gar.
A.P. Number
. City Zip Tel. w
.Palm Desert, h 92260 340-352:2. Legal Description
Contractor "
SzeVe ' jEllington Ria;
Address,,,,
ggreP 75 Pe�Ildra-mA- ..
.
City Zip
rCAthadral City, CA 9`2234
State Lic. C29 497804
8 Classif. .
Arch:, Engr.,
Designer
Address
City 360",
Lic. #
Tel.
City Zip State
- . Lic. #
LICENSED. CONTRACTOR'S DECLARATION'
1 hereby affirm that I am li_Sp6ed under provisions of'Chapter 9 (commencing with Section
7000) of Division.3tof t, usiness and Professions Code, -and my license is in force and
ffect y�
265 l: a of b° high orco
Project Description � •
wedge ..lock system garden wall
Sq. Ft. No.
Size Stories
No. Dw.
Units • -
I New ❑ Add ❑ Alter ❑ Repair ❑ -Demolition ❑
Date Owner
WORKERS' COMPENSATIONDECLARATION '
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.)
Poll No' - .Company
'Copy is filed with the city. O. Certified copy.is hereby furnished.
CERTIFICATE OF EXEMPTION FROM '
WORKERS' COMPENSATION INSURANCE
(This section need not be completed N 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 subject to the Workers' Compensation
Laws of California
Date Owner
NOTICE TO APPLICANT: ll, after making this Certificate of Exemption- you 'should become.
subject to ffie 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'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
I of rastructure
TOTAL
REMARKS'
n ' $6,625.00
ZONE:
BY:
SIGNATURE` - DATE
OWNER -BUILDER DECLARATION
.'
Estimated ValUatl
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,8usfness and Professions Code: Any city or •county which requires a
Side Str Setbatom G
permit to construct, after, 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
PERMIT
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section - 7000) of
-by:
Division 3 of the Business and Professions Code, or that. he Is exempt therefrom, and the basis
•Plan
for the alleged exemption. Any violation or Section 7031.5 by 'any applicant for a, permit
Chk. Dep.
subjects the applicant to a civil penalty of not more than five hundred dollars ($500).
Plan Chk. Bal.
❑ 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
Const.
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 inprove for the purpose of sale.)
O 1, 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.I.
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
Grading
❑ 1 am exempt under Sec. B. & P.C. for this reason
Driveway Enc
Date Owner
WORKERS' COMPENSATIONDECLARATION '
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.)
Poll No' - .Company
'Copy is filed with the city. O. Certified copy.is hereby furnished.
CERTIFICATE OF EXEMPTION FROM '
WORKERS' COMPENSATION INSURANCE
(This section need not be completed N 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 subject to the Workers' Compensation
Laws of California
Date Owner
NOTICE TO APPLICANT: ll, after making this Certificate of Exemption- you 'should become.
subject to ffie 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'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
I of rastructure
TOTAL
REMARKS'
n ' $6,625.00
ZONE:
BY:
Minimum'Setback
Distances:
Front. Setback enter
Rear Setba om Rear"
Side Str Setbatom G
Side Set from P d eerty
FINAL DATE
INSPEjA
-by:
/
Issued
Date
Validated by:
Validation:
AMOUNT
90.00
CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES N0. PLU
$
UNITS
UNDERGROUND
IST FL. S0. FT.
COLL. AREA
YARD SPKLR SYSZI-` M+.`
2ND FL. SO. FT. p
BONDING
HEATING (ROUGH)
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
FOUND. REINF.
GAS (ROUGH)
DRAINAGE PIPING
CAR P. SO. FT.
OTHER APPJEOUIP.
REINF. STEEL
WALL SO. FT.
TEMP. POLE
DRINKING FOUNTAIN
SO. FT. ®
GROUT
URINAL
ESTIMATED CONSTRUCTION VALUATION $
FINAL INSP.
WATER PIPING
NOTE: Not to be used as property tax valuation
WATER SYSTEM
FLOOR DRAIN
MECHANICAL FEES
=$
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
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.
SO. FT. RESID p 11/4 c
SEWAGE DISPOSAL
LATHING
SO.FT.GAR Q 3/ec
HOUSE SEWER
MESH
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 CON D. 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
FINAL INSP.
ROOFING
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