14576 (RER)44
P.O. BOX 1504
No. 14576
Building 78-495 CALLE TAMPICO
Address 48-118 Vista Ciel(> LA QUINTA, CALIFORNIA 92253
Owner
t Richai:d Mayer
Mailing daBUILDING-. TYPE -CONST: OCC: GRP.
me
Address
City i Zip Tel.
eta' Quinta, 'CA 92253 564-2400
A iy "Cuntz Cohctructicn
Address.
78-365 Hwy 131 Suite 148
City Zip - - Tel.:
La ' Quinta, CA 9.2253 564-6927
State Lic. City
&'.Classif:�'¢��$- Lic. # 2709
.Arch., Engr.;
Designer
i
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
]000) of Division 3 of the Business and Professions Code, and my license is in full force and
`effect: _
SIGNATURE DATE
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 ,Protessions Code: Any city or county which requires a
permit to construct, after, improve, demolish, or repair any structure, prior to its issuance also
requires the applicant for such permit to file a signed statement that he is licensed pursuant tothe provisions of the Contractor's License Law, Chapter g (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. Anyviolation of Section 7031.5 by 'any applicant for a. permit.
subjects the applicant to a civil penafty.ot not more than rove hundred dollars ($500). -
0.1, 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-
'' slruct 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 l 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' COMPENSATION INSURANCE - -
(This section need not be completed if the permit is tor.one hundred dollars ($100) valuation
or less.) -
I certify that in the performance of tho work for which this permit is issued, -1 shall not
emplogy any personA any manner soaas to become subject'fo the Work ompensation
Lawsl �/ ti rnif dug*
,bate caner` /!
_ OTICE TO APPLICANT:"H, after .makfng this��CCertiBcafe of Exempthn you should become
subject to the Workers' Compensation pr" ons of the Labor Code, yoq. must forthwith
comply wfth such provisions or this permit shdffie 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 SECTION3706 OF THE LABOR CODE, INTEREST, AND
ATTORNEY'S FEES.
This is a building perrnit when properly filled out, signed and validated,and is subject'to
expiration it work thereunder is suspended for 180 days..... - v1 . .
1 certify that 1 have read this application and state that.the.above information 16 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
Number
Legal Description
Project Description.'
install• 320 X 400 glass block
. wi.ndow.. in master bath
Sq. Ft. No. No. Dw. .
Size Stories - -Units
New ❑ Add ❑ Alter ❑. - Repair ❑ Demolition ❑
Estimated Valuation . $400.00
PERMIT
$' AMOUNT
'Plan Chk. Dep.
Plan Chk- Bal.
Const...
30.00
Mech:
Electrical
Plumbing
S.M.I. .
Grading
Driveway Enc.
I of rastructure
TOTAL
30.00
REMARKS
ZONE: ' BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Cen�ter Line
Side Setback from P o pety Line\
FINAL DATE INSPECTOR
Issued by: Date �'QI?�¢rmit V
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBIWI.EEES , 4-
1ST FL. SQ. FT. ® $
2ND FL. SQ. FT.
POR. SO. FT. ®
GAR. SQ. FT. ®
CAR P. SQ. FT. ®
WALL SO. FT. ®
SO. FT. ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTEM :- r
BAR SINK
ROOF DRAINS
DRAINAGE PIPING �
I DRINKING FOUNTAIN. M
URINAL /
WATER PIPING -
NOTE: Not to be used as property tax valuation
BONDING
FLOOR DRAIN
MECHANICAL FEES
FORMS
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL -- FLOOR SUSPENDED
OTHER APP./EOUIP.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
TEMP. POLE
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
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
f
SQ.FT.GAR ® 3/ac
HOUSE SEWER
REMARKS:
VENTILATION
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 APP./EOUIP.
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
f
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESHNITIALS
GARDEN WALL FINAL
•1 TTy'
i
'
LARRY, GUPITZ ec
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TO the. Ar ehItectVTaIr Committee',
^t
Ana
he undersigned owners,' rCquast your• epplrovrl or Lne'�
m'odi.fi•cat ionY� pTOaased on the _re,verse side Ot t`hia tour,.
'a
,p+
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A't-taohed ar Craw14np6 of the ark ,to be done t'ypsf 4;f
efatr`i�i•al to 6e• uie`6+ r.ri= t�ndicatetl .gh" the 01axings• w't
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underst;and tilt 01n0 permitt; for ho.IR• -Improvcments atis
t
re4ult..e4 Ls+e C�.�ptiof La Quiri�B , an`d Chet the 'post of th0,'
.br
perm!ted.0Ad�responaibllitr'co o,�bt.AiAIh0 p0rm.iti and
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tip
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' �'• Iubtequent*..inspe tons will oe oorne• by 'uta'
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�•;y wt atkpwIe:19e",,;.hat. all apprin 't he. orlclna.l
' •' deaipn wily deV's t our expi�n'se,f t'hat:.6ftY dafia9e to. or'
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�; "'"��•:'+ ?eloc'atl0n':o�t,exlst\l-n"p:: spr.i+nk`1e systI'AS undc10.19Und
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" utilities_, buli'1d••tng,, structure a';nd t.xtst.Tor landsco,p'ing .or
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^M =L �. ot'her''dsma0e trs,ui'tin0 from can5t,r;wCt10h of these, permitted
'
improvements v11'l' be.l et,.,our .ex.pente'and .that maintenance o,f
•;"
�1 tht permitted Lmpr,'ov'emants wiIll 'be at, our- expense.
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=• S10nature of a11v
;owners,
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