10869 (RR)Ii Q e _
4,4
P.O. BOX 1504 N o`. + 1086 9.
Addrress 53-660 Obire or, LA QUINBuildinTACCALIFORNIA 92253
• Owner Mme.
Jeanie Maxks
Mailingsame-
city,
'Address
citZip
Quinta
ua 92253
Contractor
Olson Roofing
Address.
P. 0. Box 58�t
City, Zip' Zip 92261
State Lic.
& Classif. 51.6729
Arch:, Engr:;
Designer
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number Viflr a 017, 4n O'XA AA
fel. ,{;;_-_•L.'0M1i 1 iUt 4L_ a :v.V:I
Legal Description
Project Description
PROOF
Tel.:
346-0580.
City
Lic. # 1654 Sq. Ft. No. No. Dw.
Size - •--Stories Units -
New ❑ Add ❑ Alter ❑- Repair ❑. Demolition ❑
Address
Tel.
City
Zip
State
Lic. #
•, LICENSED CONTRACTOR'S DECLARATION.
1
T I hereby affirm that I°am licenged ynder provisions of Chapter 9 (commencing with Section
(7000) of D11sbq�3Jolf thF4Bus{ipessa/gid P�rof�7i' Cade, and my license is in full force and
Yeffect. �Ja!'{`
C31J/ �dl4��lAid�6+��9�t�t
� MATURE / DATE
OWNER -BUILDER DECLARATION
`
I hereby affirm that I am exempt from the Contractors License Law for the following
Estimated Valuation 84. 00
reason: (Sec. 7031.5,Business and Professions Codec 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 to tree 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 Cade, or that. he is exempt therefrom, and the basis
for the alleged exemption. Any violationof Section 7031.5 by 'any applicant for permit
Plan Chk. Dep.
•" subjects the'applicant to a civil penalty of not more than rive 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 offered for sale. (Sec. 7044, Buisness and
-apply
const. -• zg 79 (3
• Professions Code:. The Contractor:s. License Law does not to an owner of, property who.
builds or improves' the
thereon and who does such •work.himself or through his 'own employees,
. V V
-
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.I. -
- such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
Grading
• 0 I am exempt. under Sec. B. 8 P.C. for this reason
Driveway Enc. .
Date owner
Infrastructure 4:
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
Copy is filed.with_the
-
city. ❑ Certified copy is hereby furnished..
TOTAL 2 C
CERTIFICATE OF EXEMPTION FROM
REMARKS i
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars (8100) valuation
-
. or less.)
-
- I certify that in the performance of thg 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: If, after making this Certiricate'of Exemption you should become
BY:
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:
- •
Minimum Setback Distances: - ..
Front Setback from Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY
Side Street Setback from Center Line
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.) ' ,
Side Setback from Property Line
Lender's Name
- Lender's Address
FINAL DATE INSPECTOR
This is a building permit when properly filled out, signed'and validated, and is subject to
expiration it 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 Permit
1 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.
Validated by:
Signature of applicant Date
Mailing Address
Validation: '
City, State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. 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
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN.
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
BONDING
FLOOR DRAIN
MECHANICAL FEES
FORMS
I WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
-
LAUNDRY TRAY
AIR HANDLING UNIT CFM
TEMP. POLE
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
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1% c
SEWAGE DISPOSAL
SQ.FT.GAR ® V4c
HOUSE SEWER
REMARKS:
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PLCK.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 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.
ROOFING2 02
VENTILATION
REMARKS:
FIRE ZONE ROOFING '
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESfINTMLS
GARDEN WALL FINAL :d