002620 (RR)4 44�
P.O. BOX 1504 No. 002620
Building78-105 CALLE ESTADO
Address a=eg= LA QUINTA, CALIFORNIA 92253
Owner
maning
Address
A
City Zip Tel.
. irft . .. 92253 564-50&5
Contractor
Denny t AIiateS
Address
74-478 1W My Suite I
City - ZipI Tela
State Lie.I City
& Classif. �.� Lie. #
mrcn., tngr.,
Designer
Address Tel.
City ]Zip State
Lie. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000)of Division 3 of the Business and Professions Code, and my license is in full force and
effect: t --` y f % . _
_SIGNATURE Ii- .q - DATE
j y 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, after, 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
the. provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of -
DiGision 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
subjects the applicant to a civil penalty'of not more than'rive hundred dollars ($500).
❑ I, as owner of the property, or my employees with wages as their sole compensation,.will
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and
Professions Code: The Contractor's License Law does not. apply to.an owner of property who .
builds or improves thereon and who does such work himself or through his own employees,
provided, that such improvements, are not intended or offered for sale. If, however, the building
or improvement is sold within one year of completion, the owner -builder will have the burden
of proving that he did not build or Improve for the purpose ofsa/e:)
0 I, as owner of the property, am exclusively contracting with licensed contractors to con
struct the project. .(Sec. 7044, Business and Professions Code: The.. Contractor's License Law
does not apply to an owner of property who builds or improves thereon, and who contracts for
such projects with a contractor(s) licensed pursuant to the Contractor's License Law:J -
O 1 am exempt under Sec. B. & P.C. for this reason
Date Owner.
WORKERS' COMPENSATION DECLARATION
I hereby affirm'that I have 'a certificate of consent to self -insure, ora certificate of
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy NO. Company '
❑ Copy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WO R KERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($ f 00) valuation
or less.)
I certify that in the performance of tha work for which this permit is issued, I shall not
employ anyperson in any manner so as to become subject to the Workers' Compensation
Laws of California.
Date Owner
NOTICE TO APPLICANT: If, after making this Certificate of Exemption 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 application 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. firr
Signature of applicant /``�+ 'r`�... 7/.� .+-r"r.� >/"Date �_r�-
Mailing Address t' I
City, State, Zip ✓
HARD COPY I
BUILDING: TYPE CONST. OCC: GRP.•
A.P. Number
Legal Description
Project Description
ZONE:
W BY:
Sq. Ft.
Size
No. No. Dw.
Stories Units
New M Add ❑
Alter ❑ Repair ❑ Demolition ❑
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line '
FINAL DATE
INSPECTOR
Permit
Estimated Valuation
Date
PERMIT
AMOUNT
Plan Chk. Dep..
Validation:
Plan Chk. Bal. .
A 6 4 5 3
Const.
Mech.
Electrical
Plumbing
S.M.I.
5(i
Grading
Driveway Enc.
Infrastructure
TOTALQ}
'REMARKS
ZONE:
W 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 Line '
FINAL DATE
INSPECTOR
Permit
Issued by:
Date
Validated by:
Validation:
A 6 4 5 3
1U 1 39,00 CK
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
2ND FL. SO. FT. ®
POR. SO. FT. ®
GAR. SO. FT. ®
CAR P. SO. FT.
WALL SO. FT. ®
SO. 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
SLAB GRADE
FLOOR DRAIN
MECHANICAL FEES
BONDING
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
DUCT WORK
LAUNDRY TRAY
AIR HANDLING UNIT CFM
GAS (ROUGH)
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
WATER HEATER
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/a c
SEWAGE DISPOSAL
BOND BEAM
SO.FT.GAR ® 3/ac
HOUSE SEWER
$
GRADING
CU. yd.
plus x$
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
DEC 17
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
1 V 11'J JIl91YA I UMCJIIIVI 1 IALJ,
GARDEN WALL FINAL
• Page No. - of Pages
' DENNY & ASSOCIATES ROOFING CO.
74-478 Hwy. 111 Suite #I
PALM DESERT, CA.92260
Lid. #355646
_(619) 568.9369 ..
PROPOSAL SUBMITTED TO
PHONE
DATE
STREET
JOB NAME '
CITY, STATE AND ZIP CODE
JOB LOCATION
�..
ARCHITECT
DATE OF PLANS
JOB PHONE
We hereby submit specifications and estimates for:
w t ,e ac ,
6,C t4 o c�
t%
f+ --- 3��
luF JIMPUM hereby to furnish .material and labor — complete in accordance with above specifications, for.the sum of:
✓� CAOdollars
.($
Payment to,be made as follows:
C 0" 1-iPLC-.7761 tiJ
All material is guaranteed to be as specified. All work to be completed in a workmanlike
manner according to standard practices. Any alteration or deviation from above specifica- Authorized _•
tions involving Signature
extra costs will be executed only upon written orders, and will become an
extra charge over and above the estimate. All agreements contingent upon strikes, accidents
Note: This proposal may be
or delays beyond our control. Owner to carry fire, tomado and other necessary insurance.
Our workers are fully covered by Workmen's Compensation Insurance. withdrawn by us if,not accepted within days.
Arrrptmit of f roposa! —The above prices, specifications
and conditions are satisfactory and are hereby accepted. You are authorized Si
to do the work as specified. Payment will be made as outlined above.
Date of Acceptance:
Signature
FORM 118-9 COPYRIGHT 1960 - Avallable fromccs Inc. Groton. Masa. 01450