15853 (BLCK)T4t,f 4 qxp QU&M
P.O. BOX 1504 No. 15853
Building �,; _ .' f, . l 78-495 CALLE TAMPICO
Address 0 LA QUINTA, CALIFORNIA 92253
Owner 7,=:v. C'Orc),
Mailing _ BUILDING: TYPE CONST. OCC. GRP.
Address �'.ptiQl� f'.iL'iJ11 rCYt2__
A.P. Number
City Zip Tel. "
9_2211 (619) 342-•'6880 Legal Description
Contractor 2510 1. { . of 6 " hig"I
f�ivi3la Con.-.;tru! i,r?%,. Project Description
Address
-'40 _ 5 "oleta
Cfty Zi4 R ,, Tel_,
State Lic. City
& Classif. 301 Lic. # 1 391f Sq. Ft. No. No. Dw.
Size 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) of Dlvi5ion3 at the Business and Professions We, and my license is in toll force and
`•�effeci. �
NA R --' — GATE
OWNER -BUILDER DECLARATION Estimated Valuation I hereby affirm that I am exempt from the Contractors License Law for the following 6.2",> "1 50 . 0
reason: (Sec. 7031.5,Bualness and Profasakms Code: Any city or county which requires a
permit to construct, attar, 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 PERMIT AMOUNT
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Division 3 of the 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 a permit Plan Chk. Dep.
subjects the applicant to a civil penalty of not more than five hundred dollars ($500). Plan Chk- Bal.
El 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 sale. (Sec. 7044, Bussness and Const. 4 7 3 1 i
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, 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
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- Plumbing
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 S.M-l.
such projects with a contraclor(s) licensed pursuant to the Contractor's License Law)
Grading
❑ 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 acart ified copy -the reof_ (Sec. 3800, Labor Code.)
Policy f+ Company —
&Copy is filed with the city. ❑ Cerntied copy is hereby furnished.
TOTAL 1 . (� la
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 teas.)
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 California"
Date —Owner
NOTICE TO APPLICANT: It, after making this Certificate of Exemption you should become ZONE: BY:
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith Minimum Setback Distances:
comply with such provisions or this permit shall be deemed revoked
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 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.
This is a building permit when properly filled out, signed and validated, and is subject to FINAL DATE INSPECTOR
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. Issued by: Date
I agree to comply with all city and county ordinances and state laws relating to building [
construction, and hereby authorize representatives -of thls City to enter the above- I 4
meofloned property for Inspection purposes. Validated by- I
Signature of applicant Date
Mailing Address Validation:
City, State, Zip p
CONSTRUCTION ESTIMATE
NO.
ELECTRICAL FEES
NO.
PLUMBIN3 FEES
1ST FL. SQ. FL (a
2ND FL SQ. FT. a.
POR. SQ. FT.
GAR. SQ. FT_ a
CAR P. Q. FT. ®
WALL SO. FT.
SQ. FT. a
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.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT OFM
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.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ic
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DkiL TOTAL FEES
MICHO 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.IEQUIP.
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
FINAI INSP.
ROOFING
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REMARKS:
VENTILATION
FIRE ZONE ROOFING✓���/f/��
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPEGTOR'S SlflNA7URESllNf71ALS
GARDEN WALL FINAL