9572 (SIGN)WRA
Building Address WASUINGTON S TAMPICO
Owner
RALPU' S CENTER
Mailing
Address ,a
City Zip Tel.
LA QUINTA 92253
Contractor
1!A-PERIAL SIGNS
--:'i--I2(} C:c`Y.l$ our St.
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
City Zip Tel,
I:1dio1 92201
State Lic. City
& Classif. Lic. # —
Arch., Engr.,
Designer
Address Tel.
City I Zip I State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions otChapter 9 (commencing with Section
7000) of Division 3 of the Business and Professions Coded my license Is in full farce and
affect.
SIGNATURE ` - nATF.
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 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 1a file a signed .statement that he Is 4censed pursuant to
the provisions o! the Contractor's License Law, Chapter 9 fcommenefng with Section 7000) of
Olvwcn 3 of the Business and Prolassions Code, or than. he Is exempt therefrom, and the basis
for the alleged exemption. Any vldlallon of Section 7031.5 by 'any applcanf for a permit
subjects the applicant to a ciwl penalty of not more than five hundred dollars ($500).
Cl 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 offered for safe- {Sec. 7044. Bussness 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 Ihmugh his own amptoyees,
provided that such improvements are not fnfended ar offered for seta. 8, however, the bulWing
OF improvement Is sold within one year of coMletion, 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-
struct the project. (Sec. 7044, Business and Professions Code: The Confraclor'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 I have a certificate of consent to self -insure, or a certificate of
Worker's Compensation Insurance, or a codified copy thereof. (S rt. 3800, Labor Code.)
Policy No. Company - t- r; r" -`- s 1�.
Fl Copy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100) valuation
orlass.)
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 subject to the Workers' Compensation
Laws of Cal iforn]a.
Date____L__Owner
NOTICE TO APPLICANT: I7, offer making this Certificate of EAerriptR* 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.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, Civil Code.)
Lender's Name
Lender's Address
This Is a building 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 appllcation. 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 -of this city to enter the above•
mentioned property for inspection purposes.
Signature of applicant Date
Mailing Address
City, State, Zip
No. 9572
BUILDING: TYPE CONST. OCC. GR
P. Number
Legal Description
Project Description ,l e-mpoZ aZ y
Sq. Ft. No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
PERMIT AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
COnst. f rJ r J
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTA L i- j . Q u
REMARKS
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Upr
I.
FINAL DATE ' INSrEL`TOR
Issued by: Date Permit
Validated by:
Validati
CONSTRUCTION ESTIMATE
NO.
ELECTRICAL FEES
NO.
PLUMBING FEES
1ST FL. SQ. FT. ®
2ND FL. SQ. FT ®
POR. SQ. FT. ®
GAR. SO. FT ®
CAR P. SQ. FT. (cD
WALL SQ. FT. ®
SQ. FT.
ESTIMATED CONSTRUCTION VALUATION
$
UNITS
YARD SPKLR SYSTEM
MOBILEHOME SVC.
BAR SINK
POWER OUTLET
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
$
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
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
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ_ FT. RESID ® 11/s c
SEWAGE DISPOSAL
SQ.FT.GAR ® V4c
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
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./EQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
CU. yd.
$ plus xS
=$
LUMBER GR.
FINAL INS
FRAMING
FINAL INSP.
ROOFING
`lt
^; �
�+
REMARKS:
VENTILATION
FIRE ZONE ROOFING:
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION CW
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGHA7URE9JiNITiALS
GARDEN WALL FINAL