14611 (RPL)4 J� 9
P.O. BOX 1504 N o . 14 611
Building '7- ! ' ala Lorca 78.495 CALLE TAMPICO -
Address LA QUINTA' CALIFORNIA 92253
Owner AyAandrex Home
_ BUILDING: TYPE CONST. ` OCC. -GRP.-
Addressee dl A.P. Number
el.
City Zip T
tV. Quint: , CA 9225.3 564-5407 Legal Description
Contractor .1?00 ,. And Spa
C:.. 12'r,t0L. ia. $=001S & s`�'pas Project Description .
Lake LSI Q1; in ai
Address
41-910 Boardwalk A-2
PacIhu Desert, * �P. Z'p 9'2260 TJ40.9300
State L-ic.City
& Classif.-1 C-5 3" 1-95102 Lic. # 355 Sq. Ft -
Size -
Arch., Engr.;
'Designer
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
X�7000) of Divisi6n`3 of the.Business,and Professions Cade, and my license is in full force and
effect._
SIGNATURE r X DATE
/!
OWNER -BUILDER DECLARATION
I heretr'ypflirm that I am exempt from the Contractor's License Law for the following
..reason: (S`ec, 7031.5,Business-and Professions, Code:• Any city. or - county which requires a
permit to cofistruct, 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
No. No. Dw.
Stories Units
New ❑ Add ❑ Alter ❑.. Repair ❑ Demolition ❑
Estimated Valuation
PERMIT AMOUNT
Dwislon .3 of the Business and Professions Code, or I. 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 rive hundred dollars ($500).
•-
Plan Chk. Bal.
-
70. 20
❑ 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
COr1St.Q
��%
n
Professios Code:' The Contractor's License..Law does not apply to an owner of -property .who
u
builds or Improves thereon. and who does such work himself or through his own employees,
Mech. `
24.00 -
. 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 -
- � w 00
or 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_
Plumbing
27.00
' 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 contractors) licensed pursuant to the Contractor's License Law.)
Grading
❑ 1 am exempt under Sec. B..& P.C. for this reason
Driveway Enc.
Date owner
Infrastructure
��WO KERS' COMPENSATION DECLARATION
I Iiereby�afr( that I hada to
certificate of consent self -insure, or a certificate of
Worker's�Coinp cation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Po,_,,/No. �mpany
Hr Copy iSFfiled the ❑ Certified is.hereby furnished..
with city, copy
.
TOTAL
274.20
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 thg 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." ti, 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.
MinlmumSetback Distances: ..
'
Front Setback from Center Line
Rear Setback from Rear Prop. Line
WARNING: FAILURETOSECUREWORKERS'COMPENSATIONCOVERAGEISUNLAWFUL,AND.'•
Slde Street Setback from C, e� L•in.
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,
Side Setback from Prop rty Ine
DAMAGES AS PROVIDED. FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND
ATTORNEY'S FEES.
This is a building permit when properlq filled out, signed and validated, and is subject to
FINAL DATE
INSP CTOR iii
expiration it work thereunder is suspended for 180 days. i
(Q V
I certify that I have read this application and state, that the above information is correct.
ISSUed b y
Date -
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 inspeetion'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
2ND FL. S0. FT. p
BONDING
YARD SPKLR SYSTEM
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SO. FT. ®'
GAS (ROUGH)'
DRAINAGE PIPING
WALL SO. FT.
OTHER APP.IEOUIP.
DRINKING FOUNTAIN
SO. FT. ®
TEMP. POLE
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GROUT
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SYSTEM
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FRAMING
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
REMARKS:
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
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SO.FT.GAR ® 3Ac
HOUSE SEWER
GAS PIPING
PERMIT FEE
MIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE EPL.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.IEOUIP.
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
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL