15000 (PAT)44
P.O. BOX 1504 No. 15000
Building' 78-495 CALLE TAMPICO
Address 48x-623. Vista Tierra LA OUINTA, CALIFORNIA 92253
Owner . mr. &i mfrs • Johnson
BUILDING: TYPE CONST: OCC: GRP.
Mailing y
Address ,�sa
A.P. Number
City Zip Tel.
La..Quinta'r oh 92253 564-4917 Legal Description
ContractorPatA: o Cover
Project Description
Address
City Zip Tel.:
-
State Lic. City
& Classif.. Lic. # Sq. Ft. No. No. Dw.
Size 420.. Stories Units
' Arch., Engr.,
Designer New ❑ Add ❑ Alter ❑_ Repair ❑ Demolition ❑
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
7000) tof Division 3 of the Business and Professions Code, and my license is in -full force and
effec• -
5,586.®0.
WORKERS'COMPENSATIONINSURANCE
'
SIGNATURE DATE
' OWNER -BUILDER DECLARATION
I hereby affiim that I am exempt from the Contractor's License Law for the. following
. reason: (Sec. 7031.5,Busihess and Professions - Code: Any city . or county which requires. a
permit to construct, alter, 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 to
the provisions of the Contractor's License Law, Chapter 9 (commencing with. Section 7000) of
Divfslon 3 of the Business and Professions Code, or that. he is exempt therefrom, and the basis
for the alleged exemption. Any violation of Sectfon .7031.5 by.'any applicant for a permit
sulects the applicant to a civil penalty. of not more than rive hundred dollars ($500). - - •.
p 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 buOing
or improvement is sold within one year of completion, the owner -builder. will have the burden
or proving that he did not build or 6nprove for the purpose of sale:) -
❑ 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 of.property-who builds or improves thereon, and whocontracts for
such projects with•a contractors) pcensed pursuant to the Contractor's License Law:)
• ❑ I am exempt under Sec B. 8 P.C. for this reason
Estimated ValUatlOrl
... '
'PERMIT -
-
Plan Chk., Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
-
S.M.I. -
Grading
Driveway Enc.
Dat e/elf-.�/ t Owner ~ 1 �• '
i rs
Infrastructure
. NOTICE TO APPLICANT:. d, after making this Certificate of Exemption, you should become-
" WORKERS' COMPENSATION DECLARATION
I fiereby 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.)
Policy No. Company
.❑ Copy is filed with the city. ❑ Certified copy is hereby furnished. -
" CERTIFICATE OF EXEMPTION FROM. - ' '
BY:
subject to the Workers' Compensation provisions or the Labor Code, you • must forthwith-
comply with such provisions or this permit shall be deemed revoked.
M jnlnlum Setback'Distances:
TOTAL
REMARKS
5,586.®0.
WORKERS'COMPENSATIONINSURANCE
(This section need no( 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, t 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:. d, after making this Certificate of Exemption, you should become-
ZONE:
BY:
subject to the Workers' Compensation provisions or the Labor Code, you • must forthwith-
comply with such provisions or this permit shall be deemed revoked.
M jnlnlum Setback'Distances:
'
Front Setback.from Center Lin
Rear Setback from Rear Pro/p I e
WARNING: FAILURE TOSECUREWORKERS' COMPENSATION COVERAGE -IS UNLAWFUL. AND
- Side Street Setback fro r.Lin '
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 PF rtLine.
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR -CODE, INTEREST, AND
ATTORNEYS FEES.
This is a building permit when properly filled out, signed and validated, and is subject to
FINAL DATE
I//N�� CTORA
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.
'
Issued b y
Date ( Pe ,
I agree to comply with all city and countyordinances and state laws, relating to building
construction, and hereby. authorize representatives -of this city to enter the:, above-.
for
� 90
mentloned property inspection purposes:
Validated by:
�^
Signature of applicant Date
J stl
. Mailing Address
Validation:
\
• City, State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBIW FEES
1ST FL. SO. FT. ® $
2ND FL. SO. FT.
POR. SO. FT. ®
GAR. SQ. FT. ®
CAR P. 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
WASHER(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,TEMIPERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SO. FT. ® c
BATH TUB
BOND BEAM
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/A c
SEWAGE DISPOSAL
LUMBER GR.
SO.FT.GAR ® 3/ac
HOUSE SEWER
/+
FRAMING 7
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
ROCKSTORAGE
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 7
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION /
CERT. OCC. v
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL