15115 (RPL)44
P.O. BOX 1504 N Q . 15:115 '
Buildings 78-495 CALLE TAMPICO
Addrbss . A A •y LA QUINTA, CALIFORNIA 92253,
Owner
Mr ,Sprs. Evans
BUILDING:' TYPE CONST. OCC: GRP.
Mailing -
Address44-400. Villeta A.P. Number
City Zip Tel.
La Quinta 92253. 360-3318 Legal Description
Contractor Project Description &.Aei.
Address .
5:3-300 Ramirez
City - _ Zip Tel.: .
S3
all .. 1971,53 CZ r.. r.nr
State Lic F' City
"
& Classlf Lic. #rm Sq. Ft No.' No. Dw.
Eng:,
.Arch.
' ��� Size Stories Units
Designer . ", •., New ❑ Add ❑ Alter O Repair ❑ Demolition ❑ ,
r•;
Address ',1 ' .. F ` Tel.
City Zip State
- Lic. #
LICENSED CONTRACTOR'S DECLARATION �
I hereby affirm,that.1 am licensed under provisions of Chapter 9 (commencing with Section '
7000) of Division -3 -of the -Business and Professions Coda,. and my license is in full force and -
• effect. -
SIGNATURE - DATE
OWNER -BUILDER DECLAR&TION Estimated ValUatlO,ft
I hereby affirm that I am exempt from the Contracbrs License• Law for the following i � tr 38-0`e 00
reason:.(Sec,';7031.5,Busb7ess .and Professions. Code: Ajy 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 rile a signed statement -that he is licensed pursuant to .- PERMIT AMOUNT
the provisions of Contractor's License Law; Chapter 9 (commencing with Section 7000) or.
Division 3 of tbe;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 permit Plan Chk. Dep. y �q aft
subjects the applicant toe civil penalty of not more than five hundred dollars ($500).
O I, as owner of'the property, or my employees with wag3s as their sole compensation, will Plan Chk. Bal.
do the work, and -the structure is not intended or offeree for sale. (Sec. 7044, Buisness and Const.
Professions Code: - The: Contractor's License Law does not apply to an owner or property who •(!<•
builds or. improves', thereon. and who does such work himcelf or through. his own employees, Mech. - . • �' � ` "
ll
.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. Electrical45.00. _
of proving that he did not build or improve for the purpose of sas.) 27.00
77 g
O 1, as owner of the property, am exclusively contracting with licensed contractors to coo-. Plumbing 2 s 00 -
Strutt the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law _
does not apply to an owner of property who builds or impoves thereon, and who contracts for S.M.I.
such projects witha coniractor(s) licensed pursuant to the Comractor'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 hereby' 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
O Copy is filed with the city. O Certified copy.is hereby furnished.
TOTAL 363 3i's
City, State, Zip
e
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 the work for which this permit is issued, I•shall not
employ any person' in any.manner so as to become subyect to the Workers' Compensation'
Laws of California'
Date = 'Owner
-NOTICE, TO APPLICANT.- fl, ager making this Certificate of Exemption you should become-
ZONE: -
BY:
subject to the Workers' Compensation provisions of tha Labor Code, you must forthwith
Setback
-
Distances:
comply with such provisions or this permit shall be deemed rewired.
Minimum
Front Setback from Center.Line
Rear Setback from Rear Prop. Line
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND
Side Street Setback from Center Line
SHALL SUBJECT AN EMPLOYER -TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE
HUNDRED THOUSAND DOLLARS ($100,000),.IN ADDITION rO THE COST OF COMPENSATION,
Side Setback from Property Line -
DAMAGES AS PROVIDED FOR. IN SECTION 3706 OF THE LABOR CODE; INTEREST, AND
ATTORNEYS FEES.
FINAL.DATE
INSPECTOR
permit when property filled out; signed and validated, and is subject to
This is a building pn
expiration if work thereunder is suspended for 180 days;
•:'
I certify that I have read this application and state tha;'the above information is correct:
Issued by:
Date wP�.
I agree to comply with all city and county ordinances aid state laws relating. to building .
'
construction, and hereby authorize representatives -of this city.'to enter' the above.U4
.
mentioned property for inspection purposes.
Validated by:
' I
Signature of applicant Date"
j
.1)
. Mailing Address
Validation:
1�1 RIIAV
City, State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBIW FEES
1ST FL. SO. FT. ® $
UNITS
SLAB GRADE
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL. SQ. FT.
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
FOR. SO. FT. ®
GAS (ROUGH)
METER LOOP
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
GAS (FINAL)
TEMP. POLE
DRAINAGE PIPING
CARP. SQ. FT. ®
GROUT
WATER HEATER
WALL SO. FT. ®
FINAL INSP.
DRINKING FOUNTAIN
SQ. FT. ®
WATER SYSTEM
URINAL
ESTIMATED CONSTRUCTION VALUATION $
=$
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
FIRE ZONE ROOFING
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.
SQ. FT. ® c
BATH TUB
LATHING
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 1'/e c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ac
HOUSE SEWER
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
UNDERGROUN
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
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REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL :d