15146 (PLBG)4
Building
Address 48-623 Vista Tie
OwnerA
Chuck and Ratty
Mailing
Address,;e.ng .aS .above
City Zip
La. QLlint a 92253
Contractor .
owner/builder
Address
City ]Zip
State Lic.
& Classif..' t'•F
Arch., Engr., r' `
Designer
Address
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Tel.
. 564a-49$7
Tel.:.
City
Lic. #,
l
Tel.
2 .
No. 15146
JILDING:• TYPE CONST. OCC: GRP. -
P. Number
Igal Description
oject Description 177 beer Water Feature
Sq. Ft.
Size .
New ❑
Add ❑
.No: No. Dw.
Stories - Units
Alter ❑ -
Repair ❑
Demolition. ❑
City
Zip
State
Lic. #
,. LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I.am licensed under provisions of Chapter 9 (commencing with Section
Itof Division 3 of the Business and Professions Code, and my license.is in -full force and
• effec
SIGNATURE DATE
' OWNER -BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractor's License Law for the following
reason: (Sec. 703,1.5, Business and Professions 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 to
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Division 3 of the Business and Professfons Code, of that. he is exempt therefrom, and the basis .
for the alleged exemption. Any violation of Section 7031.5 by 'any applicant for a permit
�sub'ects the applicant to a civil penalty of not more than rive hundred dollars (5500).
, , as.owner of.the property, or my employees with wages as their sole compensation, will
XII
Estimated Valuation -$1,000.00
_ PERMIT AMOUNT
.Plan Chk. Dep. -
Plan Chk. Bal. 16.25
Const.. Q �i .
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
Mech.,
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 wfthfn one year of completion, the owner -builder will have the burden
of proving that he did not build of trnprove for the purpose of sale.)
Electrical -
5J + t'% 0
Plumbing 21.00
❑ 1, as owner of the property, am exclusively contracting with licensed contractors tc 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 who contracts for .
such projects with contractors) Licensed pursuant to the Contractor's License Law.)
❑ I am exempt under Sec B. & P.C. for this reason
S.M.I.
Grading
-
Driveway Enc.
XDate! � ° �'t tr3Owner ! },t i' ii 1 - r t
Infrastructure-
-WORKERS! COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self -insure, or a certificate of
Worker's Compensation Insurance, ora certified copy thereof. (Sec. 3800,.Labor Code.)
\
Policy No. Company
❑ Copy is filed with the city, ❑ Certified copy is hereby furnished. .
TOTAL 1 7 _ 2_5
REMARKS
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
i .1
(This section need 'not be completed ff the permit is for one hundred -dollars (5100) va'uation
' or less.) -
I certify that in the performance of thip 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. g, alter making this Certificate • of Exemption you should become
subject to the Workers' Compensation provisions of the Labor code,. you must forthwith
comply with such provisions or this permit shall be deemed revoked.
ZONE: BY:,
.Minimum Setback Distances:
Front Setback from Center Line
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND
SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE
Rear Setback from Rear P - e
Side Street Setback fir ter LI e '
*Pr'
' HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION,
Side Setback from y Lin
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND
ATTORNEY'S FEES.
This -is a building
g permit when properly filled out, signed and validated and is subject to
expiration if 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 .01 this city to enter the. above..
mentloned property for inspection purposes. -
FINAL DATE V P1 IT : .r
. . y
Issued by: Date P.e'it.:
Vdlldated by: U�
Signature of applicant Date-
Mailing Address
Validation:
/
City, State, Zip
`
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBIW FEES
1Sf FL. SO. FT. ® $
UNITS
COLL. AREA
2ND FL. SO. FT. ®
ROUGH PLUMB.
YARD SPKLR SYSTEM �
POR. SO. FT.
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CARP. SO. FT. ®
ROUGH-WIRINP
DRAINAGE PIPING �
WALL SO. FT.
FOUND. REINF.
DRINKING FOUNTAIN
SO. FT. ®
METER LOOP
URINAL
ESTIMATED CONSTRUCTION VALUATION $
- REINF. STEEL
WATER PIPING
NOTE: Not to be used as property tax valuation
TEMP. POLE
FLOOR DRAIN
MECHANICAL FEES
GROUT
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
BOND BEA 1.
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
LUMBER GR.
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 ® 1+/a c
SEWAGE DISPOSAL
FIREPLACE
SO.FT.GAR ® 3/ac r
HOUSE SEWER
• SPARK ARRESTOR -
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 ELECTRICALa
HEATING & AIR COND. SOLAR '
1 ■
SETBACK
GROUND PLU
UNDERGROU
A.C. UNIT,
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTI
TANK
ROUGH-WIRINP
DUCT WORK
ROCKSTORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
- REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEA 1.
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
_$
LUMBER GR.
FINAL INSP.
FRAMING
F.INAL INSP
ROOFING
/
,
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
• SPARK ARRESTOR -
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTIO
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIONATURESIINITIALS
GARDEN WALL FINAL