07212 III�IIIIIIIIIIIIIIIIIIIII 124
IE f�'§� +Q
P.O. BOX 1504 No. V 1 2 j 2
Address 75-749 Avenue 50 LA QUINOTACCALIFORNIA 92253
Owner 14• J• Bek
Mailing
BUILDING: TYPE CONST. OCC:GRP.-
AddressHO E. Rincon St, A.P. Number TT 2W9
City Zip Tel.
. Carona 191773 1714-736-0711 Legal Description
Contractor Project Description Trailer-Tem Poser
Same
Address
City Zip Tela
State Lic. City
&Classif. Applied for Lic.# Applied for Sq. Ft. No. No. Dw.
Arch.,Engr., Size Stories Units
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 Division 3 of the Business and Professions Code,and my license is in full force and
effect �.
SIGNATURE DATE
OWNER-BUILDER DECLARATION Estimated Valuation
1 hereby affirm that I am exempt from the Contractor's License Law for the following -0-
reason: (Sec. 7031.5,14usress 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 tie a signed statement that he is licensed pursuant to PERMIT AMOUNT
the provisions of the Caebacor's License Law, Chapter 9 (commencing with Section 7000) of
Division 3 of the Busyness 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 appigmt to a awiponaty of not more than five hundred dollars($500).
❑I,as owner of the property,or my employees with wages as their sole compensation,will Plan Chk. Bal.
do the work,and the structure is not intended or offered for sale.(Sec. 7044,Buisness and Const. • {�
Professions Code: The Contractor's License Law does not apply to an owner of property who
builds or irproves thereon and who does such work himself or through his own employees, Mech.
provided that such improvements are not intended or offered for sale. ff, however, the building
Of improvennent is sold wV9 ane year of completion, the owner-builder will have the burden Electrical
of proving that he dill not build or improve for the purpose of safe.)
❑ 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 appy to an owner of property who broads or improves thereon, and who contracts for S.M,I,
such projects with a contractor(s)Evemsed pursuant to the Contractor's License Law.)
Grading
❑I am exempt under Sea a_&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
Workers Compensation Insurance,or a certified copy thereof.(Sec.3800,Labor Code.)
Policy No Company
❑Copy is find with the city. ❑Certified copy is hereby fumished.
TOTAL �•�
CERTIFICATE OF EXEMPTION FROM REMARKS
WORKERS'COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100) valuationor 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
N077CE TO APPLICANT` If. after makig this Certificate of Exemption you should become ZONE: BY:
sutyect to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such Provisions ordiftPermit~bedeemed revoked. 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,Chd Code.) Side Setback from Property Line
Lenders Name
Lenders Address
This is abuilding permit when property filled out,signed and validated,and is subject to FINAL DATE INSPECTOR
expiration it work thereunder is suspended for 100 days. Q
1 certify that I have read this application and state that the above information is correct. Issued by: Date ��110 Permit
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. Validated by:
Signature of applicant Date
Mailing Address Validation:
City, State, Zip
CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES
1ST FL. SO.FT.® $ UNITS
YARD SPKLR SYSTEM
2ND FL SO.FT.
MOBILEHOME SVC. BAR SINK
POR. SO.FT.
GAR. SO.FT.® POWER OUTLET ROOF DRAINS
DRAINAGE PIPING
CARP. SO.FT.
WALL SO.FT.@
DRINKING FOUNTAIN.
SO.FT.@
URINAL
ESTIMATED CONSTRUCTION VALUATION $ 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 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 -----dAMPERES SERV ENT SHOWER
BOILER B.T.U. SO.FT.®c BATH TUB
SO.FT.®c WATER HEATER
MAX.HEATER OUTPUT,B.T.U. SO.FT.RESID®11/4 c SEWAGE DISPOSAL
SO.FT.GAR®3/ac 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 APPJEOUIP.
REINF.STEEL GAS(FINAL) TEMP.POLE
GROUT WATER HEATER SERVICE FINAL INSP.
BOND BEAM WATER SYSTEM
GRADING
LUMBER GR. FINAL INSP. cu.yd.
FRAMING FINAL INSP. $ plus x$ =$
ROOFING REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION 1
l
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
IIIIIIIIVIIIIIIVIIIIIII 13 44
"
IEC&,Y/ A�/
P.O. BOX 1504 No. 07213
Building 78-105 CALLE ESTADO
Address Brock ftvelOpimet1L LA QUINTA,CALIFORNIA 92253
Owner 14. J. Brock
Mailing BUILDING: TYPE CONST. OCC:GRP.
Address 250 E. Rancor $t•
A.P. Number
City Zip Tel. $g, permit for Tract 25389
Corona ' 773 1714-736-0711 Legal Description
Contractorg
Project Description signs
Sam
Address
City Zip Tela
State Lic
&ClassifAppl idd foT City Lic.# �A pl ied for
Sq.Ft. No. No. Dw.
Arch.,Engr., Size Stories Units
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 Division 3 of the Business and Professions Code,and my license is in full force and
effect. ,
SIGNATURE DATE
OWNEWBUILDER DECLARATION Estimated Valuation j(3O(} (}(}
I hereby affirm that I am exempt from the Contractor's License Law for the following •
reason: (Sec. 7031.5,Buskress 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 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 aDeged 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).
❑I,as owner of the property,or my employees with wages as their sole compensation,will Plan Chk. Bal.
do the work,and the structure is not intended or offered for sale.(Sec. 7044,Buisness and Const. 33•
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 safe.)
❑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.1.
such projects with a contractors)licensed pursuant to the Contractor's License Law.)
Grading
❑I 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 a certified copy thereof.(Sec.3800,Labor Code.)
Policy No. Company
❑Copy is filed with the city. ❑Certified copy is hereby furnished. * +►
TOTAL S
CERTIFICATE OF EXEMPTION FROM REMARKS
WORKERS'COMPENSATION INSURANCE
(Ibis section need not be completed if the permit is for one hundred dollars ($100) valuation
or less.) - {k1 ►'" �;�f ` 41164 ,EU i.� .4��,{?4jr» !
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
alifornia.DateOwner
NOTICE TO APPLICANT: n, after making this Certificate of Exemption you should become ZONE: BY:
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provlsionsorthis Permit shall bedeemed revoked. 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
Lenders Address FINAL DATE INSPECTOR
This is a building permit when properly filled out,signed and validated,and is subject to /90
expiration if work thereunder is suspended for 180 days. 318
1 certify that I have read this application and state that the above information is correct. Issued by: Date Permit
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. Validated by:
Signature of applicant Date
. Mailing Address Validation:
City, State, Zip
CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES
0
1ST FL. SO.FT.® $ UNITS .
YARD SPKLR SYSTEM
2ND FL. SQ.FT.
MOBILEHOME SVC. BAR SINK
POR. SO.FT.
GAR. SO.FT.® POWER OUTLET ROOF DRAINS
DRAINAGE PIPING
CAR P. SO.FT.
DRINKING FOUNTAIN.
WALL SO.FT.
URINAL
SO.FT.
ESTIMATED CONSTRUCTION VALUATION $ 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 LAUNDRY TRAY
AIR HANDLING UNIT CFM 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. SQ.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®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
SETBACKAlfr-ROUND PLUMBIN 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.
OUND.REINF.7GAS(ROUGH) METER LOOP HEATING(FINAL) OTHER APPJEQUIP.
REINF.STEEL GAS(FINAL) TEMP.POLE
GROUT WATER HEATER SERVICE FINAL INSP.
BOND BEAM WATER SYSTEM
GRADING
LUMBER GR. FINAL INSP. cu.yd.
FRAMING FINAL INSP. $-Plus-X$-=$
ROOFING REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION 1
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS �
GARDEN WALL FINAL