13630 (RR)T4hf 4 4 a"
9�i.lding 54-976 Ave. Obregon
Owner Walt Abdefeld
Mailing
Address Same
City zip
La Quintat, CAI 92253
Contractor
The Nelson Roofing co.
YX. Box 584
City
Palm Desert,l& 92261
�tate Lic.
& Classif. C39 516729
-Arcn., trigir.,
Designer
Address
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
1 1
BUILDING: TYPE CONST
P. Number
Tel.
564-3893 Legal Description
1Project Description Rexcef
City
Lic. # 654 Sq. Ft.
Size .
Tel.
New 0 Add 0
City
Zip
State
I
I Lic. #
LICENSED CONTRACTOR'S DECLARATION
emMaffirm that I am licensed under Provisions of Chapter 9 (commencing with Section
7P 0) of ivision 3 of the Business and Profe!fsions Code, and my license is in full force and
.14,
ect.//
r DATF
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
Estimated Valuation
PERMIT
pennif 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
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
subjects the applicant to a civil penalty of not more than five hundred dollars ($500).
0 1, as owner of the property, or my employees with wages as their sole compensation, will
Plan Chk. Dep.
Plan Chk. Bal.
do the w. rk, 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. it, however, the building
Const.
'Mech.
or improvement is sold within one year of completion, the owner -builder will have the burden
ofproving that he didnot buildorimprove for thepurpose ofsale.)
Electrical
0 1, 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. 1.
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
0 1 am exempt under Sec.—B. & P.C. for this reason
Grading
Date —Owner
WORKERT COMPENSATION DECLARATION
klehereby affirm that I have a jertificate of consent to self -insure, or a certificate of
Wor r's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No.,e!!!�
Company
CAC'—opy is filed with the city. 0 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) valuition
or less.)
I certify that in the performance of thp 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 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.
I
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
tfender's Addres —
This is a builditn permit when properly filled out, signed and validated, and is subject to
expiration it work 4reunder is suspended for 180 days.
I cer tify 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.
Signature of applicant —Date—
Mailing Address
City, State, Zi
Driveway Enc.
Infrastructure
TOTAL
REMARKS
No.
OCC. GRP. -
13630
No. No. Dw.
Stories Units
Alter 0 Repair 0 Demolition 0
1500.W
AMOUNT
30. OU
ZONE: 7 BY:
Minimum Setback Distances:
Front Setback from Center Line-
-Rear Setback from Rear Prop. Li ne—
Side Street Setback from Center Line
FINAL I
Issued k
ValidatE
Validati
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SQ. FT. @ $
UNITS
SLAB GRADE
2ND FL. SQ. FT. @
BONDING
YARD SPKLR SYSTEM
STORAGE TANK
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. @
DUCT WORK
ROCKSTORAGE
GAR. SO. FT. @
POWER OUTLET
ROOF DRAINS
CAR P. I SO. FT. @
OTHER APPJEQUIP.
DRAINAGE PIPING
WALL SO. FT. @
d
TEMP. POLE
DRINKING FOUNTAIN
SO. FT. @
GROUT
URINAL
ESTIMATED CONSTRUCTION VALUATION $
FINAL INSP.
WATER PIPING
NOTE: Not to be used as property tax valuation
WATER SYSTEM
FLOOR DRAIN
MECHANICAL FEES
MATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET'
COMPRESSOR HP
POLE, TEMIPERM
LAVATOR
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SO. FT. @ c
BATH TUB
SPARK ARRESTOR
SO. FT. @ c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID @ 11/4 c
SEWAGE DISPOSAL
LATHING
SO.FT.GAR @ 3/4c
IHOUSE SEWER
MESH
GAS PIPING
INSULATION/SOUND
PERMIT FEE
PERMIT FEE
FINISH GRADING
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
I CONST. FEE ELECT.FEE
SMIFEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
GROUND PLUMBING
UNDERGROUND
A.G. UNIT
COLL, AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCKSTORAGE
FOUND. REINF.
GAS(ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BONDBEAM
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
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL