15685 (MISC). u�ci�,i6v
f ,
t4�A 4
P.O. BOX 1504 No. 15685 -
Building 78-495 CALLE TAMPICO
Address'. 47-555 Via Monterro LA QUINTA, CALIFORNIA 92253
Owner Manner Construction
Mailing BUILDING:. TYPE CONST. OCC: GRP.
Address 154 I,. Desert. Falls Dr.
A.P. Number
CityZip Tel.
Pa Lm. Desert. 'A 92260 Legal Description
ContractorProject Description 175 1• f. of 5`4" high torn
Steve Ellington Masonry wedge lock system .
Address
68675 Panaroma ter. "•
Ci Zip - Tel
eat1ledral Cit fi CA 92234 320-9481
State Lic.City
& Classif..- 1929-'497804 Lic. # 3607 Sq. Ft. No. No. Dw.
Arch., Engr., "
Size Stories Units
Designer New ❑ • Add ❑ Alter ❑ Repair ❑- Demolition 0
Address Tel.
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby�_IIT
fitm th 1 1 am licj)nsed under provisions of Chapter -9 (commencing with Section
7000) of Disior0 f t e.ediness and Professions Code, and my license is in full orce/And
effect -
IGNATIJR�" I DATE `
Y
OWNER -BUILDER DECLARATION Estimated Valuation
I hereby affirm that 1 am exempt from the Contractors License Law for the following ��'�.• Q
• reason: (Sec. 7031.5,Sustness and Professions Code: Any city or county which requires a - 9
permit to construct, after, improve, demolish, or repair any structure, prior to its issuance also ' I
requires the applicant for such permit to rile 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) or
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.
subjects the applicant to a civil penalty of not more than rove hundred dollars ($500).
❑ 1, as owner of the property, or my employees with wages as their sole compensation, will Plan Chk. Bal. _
do the•work,-work,structure is not intended or offered for sale. (Sec. 7044, Buisness and Const..
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, McCh- '
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 Me burden Electrical
of proving that he did not build or bnprove for the purpose of 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
O 1 am exempt under Sec. B. & P.C. for this reason
Driveway Enc.
Date Owner 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 certified copy thereof. (Sec. 3800, Labor Ccde.J '
Policy N .•�� Company '
Iy is filed with the city. ❑ Certified copy is hereby furnished.
TOTAL \ • '�
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 tho 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 -
Law of rm
s Calif
I oa.
Date -Owner
NOTICE TO APPLICANT: If_ after making this Certificate of Exemption, you should become •
ZONE:
BY: '
subject to the Workers' Compensation provisions of the Labor Code, you .must forthwith
comply with such provisions or this permit shall be deemed revoked. '
Minimum Setback Distances:
Front Setback from Center Line
WARNING: FAILURE TO SECURE
Rear Setback from Rear R Llne" '
WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND
SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE
Side Street Setback from/ nte'T"iLine "
HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION,
Side Setback from,e Line
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND
y
Ca)
ATTORNEYS
This is a buildin g permit when properly filled out; signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days.-
ays.
FINAL DATE
•INSPECTOR ll
Y�
1,
1• certify that I -have read this application and state that the'above information is
Issued
Date �ls �Pe'rmit
correct.
with all city and -county. ordinances and state•laws relating to building.
` I agree to on,
construction, and hereby authorize representatives -of this city to enter the
b y
t �s y
,'above-.
mentioned property for inspection purposes.
Validated by:
Signature of applicant Date'v.5
f I
Mailing Address
Validation;
City, State, Zip
! �//
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBINU FEES
1ST FL. SO. FT. @ $
2N0 FL. SO. FT.
POR. SO. FT. @
GAR. SO. FT. @
CARP. SO. FT. @
WALL SO. FT. @
SO. FT. @
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
HEATING (ROUGH)
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
DUCT WORK
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
HEATING (FINAL)
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
BOND BEAM
SO. FT. @ c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID @ 11/4 c
SEWAGE DISPOSAL
LUMBER GR.
SO.FT.GAR @ 3/.c
HOUSE SEWER
FRAMING
FINAL INSP.
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 APPJEQUIP.
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 SIGNATUREWINITIALS
GARDEN WALL FINAL
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