15624 (RR)D� �l
Buildin
Addres
Owner
F.O. BOX 15047.
No. 15624 .. ,
78-495 CALLE TAMPICO
P620/610/600 Vi.S LA-QUINTA, CALIFORNIA 92253 '
Mailing
Address 50-10
.7 OM110.• Oaxaca
City Zip • `' • ' Tel.
La.• ,eialta 92253...',,
Contractor =;
lrvant ' ilaiversal
ess
46:2 . Lai. C4MP a' Way
Zip Tel:.
S
xn ting 92260 324-6422
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number '
f.
Legal Description
Project Description Re' , = -f existing. built—UD I
with poivu e a i f✓ caa� a:� coating.
� ter, -
State Llc
City
�t 4
& Classlf
Lic. # ; :-
r.a9
Sq. Ft."r 146'."'No. Dw. ?'
Size Stories Units
Arch, En r6�7
Designerg
New ❑ Add ❑ Alter ❑ Repair ❑ Demohtlon 0
Address 1 , ,° `
Tel.
,_'
e
CityZip
.
State
LICENSED CONTRACTOR'S DECLARATION
I hereb affirm that I am'llceng under provisions of Chapter 9 (commencing with Section
7000) Division 3 of the and Professions. Code, and my license is in full force and • -
,
:
/Business
eff�a.ss�sP'' -�
t
SIGNATURE - DATE
,
OWNER -BUILDER DECLARATION
1 hereby affirm that, I em exempt from the Contractor's License'Law for the following -
Estimated Valuation'
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reason: (Sec. 7031.5,Business and Professions Code:. Any city. or county which requires a ,
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Permit to construct, after, Improve, demolish, or repair.any structure• prior to its issuance'also�
_ q app permit -
requires the applicant for such g p
file a signed statement .that he is licensed u7000)
PERMIT x,: Y: - AMOUNT -
the provisions o/ the Contractor's License law, Chapter 9 (commencing � with Section 7000) of
n of
' Division 3 of the Business and.'Professkms Code, or that. he is exempt therefrom, andthe basis
for the Any Section 7031.5 by 'any for
-
Plan.Chk. Dep.
alleged exemption. violation o/ applicant r permit ..
_subjects the applicant to a civil penally of not more than rove hundred dollars .($500). -
_
Plan Chk• Bal. -
❑ 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 offeredfor sale. (Sec. 7044, Buisness andCOr1St:
Professions Code: ,The Contractor's License Law does not apply to an owner of property who
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builds or. Improve's thereon and who does such work himself oi.through: his own employees,
Mech:
- 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 •� ' -
o/ proving that he did not build or 6nprove lor,the purpose o/ sale.) -
x+ .
' O'I, as owner'of the property, am exclusively contracting with licensed contractors to con-
Plumbing -
struct:the project. *(Sec: 7044,•Busfness.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.
such projects with'a contractors) licensed pursuant to the Contractor's License Law.) -.
Grading ~
❑ lam 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 c: 3800, Labor Code:)
`:Company
Policy Nom a�"pint.:. fS`t" rA .
❑Copy is filed with the city, . ❑ Certified copy is hereby furnished::
'
TOTAL
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.) . - ..
a
I certify that in the performance of the work for which this. permit is issued, I shall not
employ any erson in'any manner so as to becorne.subject to the Workers' Compensation.
Laws of California
Date Owner
,.: NOTICE TO APPLICANT: N, after makfng'this Certificate of Exemption' youshould become ;,-;
ZONE: - - ' BY:" w
subject to --the Workers" Compensation provisions o/ the Labor Code, you must -forthwith
comply with such provisions or this permit shall be deemed revoked: -
--- -.
Minimum Setback Distances:'..
'rte Front Setback from Center Line
Rear'Setback from Rear Prop. Line
• WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE ISUNLAWFULrAND
Side Street Setback fromCenter Line
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 Property Line— ,
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF.THE LABOR CODE, -INTEREST, AND
ATTORNEY'S FEES.. - .. -
-permit
.. ..•
FINAL DATE - 'INSPECTOR
This is a building when properly filled out; signed and validated, and is subject to:
-, expiration if work thereunder is suspended for 180 days.
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I.certif that I have read this..
y application and state that the above information is correct, �
'
.• Issued by Dat, Permit
I agree to comply with all city„ and county.ordinances and state laws: relating to building
-
construction, and. hereby ,authorize representativesr'-of this city to enter. the above
mentioned property for inspection
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purposes:,.-'
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t
Validated by:
.
Signature of applicant +r rr s. ,Fe��'✓ c Dater��
a
Mailing. Address
Validation:
City, State, Zip
,
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBIW FEES
1ST FL. SQ. FT. ® $
2ND FL. SQ. FT.
POR. SQ. FT. ®
GAR. SQ. FT. ®
CAR P. SQ. FT.
WALL SQ. FT. ®
SQ. FT. ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTEM
BAR SINK
I ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
ROUGH PLUMB.
FLOOR DRAIN
MECHANICAL FEES
HEATING (ROUGH)
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
ROCK STORAGE
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
OTHER APPJEOUIP.
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.
SQ. FT. ®c
BATH TUB
WATER SYSTEM
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ac
HOUSE SEWER
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
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
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
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION iA 90
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL