PLBG (11792) + RR (9744)52320 Avenida Madero
11792
9744
- 11T92'-
,. P.O. BOX 1504 No. -
tBuilding ' 78=105CALLE ESTADO
Address '52`320 Madero LA QUINTA, CALIFORNIA 92253
Owner
Mailing t.-: ;. ' BUILDING: TYPE CONST. - OCC. GRP.
Address sr,P.0. R01t 1.555
A.P. Number
City Zip Tel.
L3 •Qt3.192.253 , Legal Description `,~
Contractor ,tae.we'r. Connectr;
R, StevenS0,n/RVG -P1. il,gw Project Description
Address . ,, .. - .. - • - - '.
74110 V61a do
City Zip Tel.:
Palm Deh 92260 341-9224
State LiaCity
2328 .
& Classif. R iii 39.6'• Lic. # " ' Sq. Ft. N0. No. Dw.
` Size Stories Units.'
^Arch.; Engr., , .:
•Designer s a _ "• ; • New ❑ Add ❑ Alter.❑ Repair ❑ Demolifiori ❑
Address ; ; r - Tel.
:City Zip~ State
Lic.# e
` LICEVED CONTRACTOR'S DECLARATION
I hereby affirm tf)at 1 ag_(jicensed•undei provisions%f Chapter 9 (commencing with Section + ,t
7000) 01 D}}ivisionn 3•of t ejBus'in(e"ss a fdlProfe'ssio s.CJo de, and my license in fu forrcesan d/ ». _ „ r. y
ffecL f / J / . ii''r IJ fp;' i
.( IGNATURE/ &V - %i 4 \/i+' 1 Wit v 1, ! DA; - T , xr.- kr • i
,11 OWNER•B61LDER DECLARATION , y
Estimated Valuation$1,00-0.00
I hereby affirm that I am exempt from the Contractors License Law for the followin
reason: (Sec. 7031:5, Business and: Professions Code: Any city ori county which requires a
Permit to construct, alter,' Improve,' demolish, or repair any structure, prior to its issuance' also . AMOUNT
requires the applicant for -such permit to file a signed statement that he is licensed pursuant to PERMIT "
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 - k
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,(8500). Plan Chk. Bal• `
❑ 1, 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 COnStt
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 Mech.
or improvement is sold within one; year of completion, the owner -builder will have the burden Electrical
Oi
of proving that he did not. build or improve for the purpose of sale.) - A -
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing 30.00
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. t • -
^such projects with a contractor(s) licensed pursuant to the Contractor's License Law:)
J Grading
' ❑ 1 am exempt under Sec. •' B. & P.C. for this reason
Driveway Enc.
Date ` owner Infrastructure
WORKERS' COMPENSATION DECLARATION.
I hereby affirm'that,Fhave 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 - t.
❑ Copy is filed with the city. -,. ❑ Certified copy is hereby furnished.
, r
TOTAL 30. ou
+, y CERTIFICATE OF EXEMPTION FROM:1 REMARKS
WORKERS' COMPENSATION INSURANCE r/ . '
or ess.is clion need not be•complet d if f"a permit is for onethuntled dollars i ($100) valuation ' -..err ens+ Z h"Y:41.- ..•r!id -Cs.' =:•.,, ,4 } .
i Y_ s r ..1.+r. y,r y...1 ;5V !;
• I certify that m the performance of tag work,for whicti this per' it isoissued, I shall not ,- Raf3r f. i Pf L. ', .fx,3
employ any person in any manner s6'" Yl ' econfe suti' to the' Workers Com ensation
Laws Jof Ca fornia' } y f, }( rr j[) f
Date_ Jngr '/' , " , 'j. i Y it ! p '
NOTIPE TO APPLI AN}1' +alterlm l1rrfag/ h s Cghificat"i—'f-'Exempho0' you phould become ZONE: BY: -
subject'to the Worke/s Compensaf( 'provision. of the Labor Code, you ust 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
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 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 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
w
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL. SD. FT.
FORMS
SEWER
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
GAS (ROUGH)
METER LOOP
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
GAS (FINAL)
TEMP. POLE
DRAINAGE PIPING
CAR P. SO. FT. ®
GROUT
WATER HEATER
WALL SO. FT.
FINAL INSP.
DRINKING FOUNTAIN.
SO. FT. ®
WATER SYSTEM
URINAL
ESTIMATED CONSTRUCTION VALUATION $
=$
WATER PIPING
NOTE: Not to be used as property tax valuation
FRAMING
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
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SQ. FT. ® c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1+/a c
SEWAGE DISPOSAL
INSULATION/SOUND
SO.FT.GAR ® 3/ac
HOUSE SEWER
FINISH GRADING
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
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP./EQUIP.
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
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
Address:
m
Account No.
.Service Address
❑ Meter(s)
❑ Service(s)
❑ Backflow(s)
❑ House Lateral(s)
❑ DetectorCheck(s)
❑ Meter Surcharge
Sanitation Capacity Chargee'
❑ W.S.B.F.C.
❑ Temporary Construction Meter
❑ Turn on Charge
❑ Uncollected Account - Name
❑ Inspection Fee - Tract -
Fee -
❑ Plan Check Fees Water / Sewer -
Tract -
❑ Bond Payment - A.D. - Bond
Assmt.
❑ Customer Deposit
❑ Other_
Lot(s)
9
G.A. Code
Remarks: TOTAL TOTAL $ 5 U
❑Copy to: C 2/
Cash
40
Check / 7 7 • " a Water Service ,
Money
Order Cashier
CVWD-438(11/89)
i P.O. BOX 1504 U.
Building52-320iA i RO •7&105 CALLE ESTADO
Address LA QUINTA; CALIFORNIA 92253'
Owner
BRUCE FERTIL B.EROOP
Mailing BUILDING: TYPE CONST: OCC:.GRP.
Address BOX 1459 A.P. Number
City ; Zip Tel.
AVALON, CA 90704 213-5110-0443 Legal Description '
Contractor Project Description REROOF ROCK BOOP WITIf
PRO TECH ROGFII3G
Address _ ASPHALT SHINGLES
30-655 AVREUE DEL — YER140
City' Tel.: ,r
CATAE0RAL CIT`Zip 92234 , ' 770-9693
State Lic. City
& Classif. - '61155,15* Lic. # '1925 Sq. Ft. No. No. Dw!
•Arch.,•,Engr.;,
Size Stories' Units.-
• `Designer New ❑ _Add ❑- Alter ❑ Repair ❑ " .-Demolition ❑
Address Tel.
City Zip State .
Lic #
LICENSEE CONTRACTOR'S DECLARATION
I hereby affirm that'I am licensed under provisions of Chapter 9,(commencing with Section
7000) Of Dlvision 3 oVthe Bu's1ness and•Professions Code; and my license is in full force and
effect. s' './ -is
r f' fd.f `
s q
.. . i7 . . -jl.O .t+ ,P, { j O °3 '.'. f -• Y d. 1 `•i
f r
'0 + i 7 11 4 r P+' !►(1
SIGNATURE '' ' ! 1 ,.^' - • li•✓` DATE
OWNER•BUILDERDECLARATION -
`.'.I hereby affirm that Lam exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Business and Professions Code: Any, city or county whichrequires a
"-permit to construct, alter, improve, -demolish, or repair any structure, prior to Its issuance also
requires the applicant for such permit to tile.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 rive hundred dollars ($500).
❑ I, as owner of the property, or my employees with wages as their sole compensation, will
do
ado the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and
3 Professions Code: The Contractor's License Law does not apply. to to an owner of property who
. .
Estirnated Valuation $ 1 1950.00
- -.
:PERMIT. AMOUNT
- .,
- '
' Plan•Chk. Dep.'
Plan Chk. Bal -
- $45;00
--Mech. '
builds or Improves thereon; and who does such - work himself or through his oivn. employees,
,,:.. provided that such Improvements are not Intended or offered. for sale. If, however, the building
dry 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 of sale.)
Electrical-
Plumbing
O 1, as owner of the property, am exclusively contracting with licensed contractors to con-
-strucl 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.)
❑ I am exempt under Sec. B. 8 P.C. for this reason
S.M.I. ' •.... -.20'-
_- ,
Grading
-
Driveway Enc.
Date Owner
a Infrastructure
WORKERS' COMPENSATION DECLARATION. ,
l . • y
' I hereby'afflrm that I have a certificate of consent to self -insure, or's certificate of
• Worker's Compensation Insurance, or a certiti r coppy ergotp..,(Se 3800; Labor Code.)
- -
hs..Policj NO. ' ' .. Company • •tiSl. -PUIr
ropy.is filed with the city. • ❑ Certified copy is hereby furnished.. ,
TOTAL $45.20
-
CERTIFICATE OF EXEMPTION FROM .
WORKERS' COMPENSATION. INSURANCE•:. .:
REMARKS' '"r'•
- •• - _
(This section need not be completed ff the permit is for one hundred dollars ($100) valuation
. or less.)
I certifyahat in the performance of thg work for which this permit is issued, I shall. not
• employ any pperson 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. • ,. -
•+ y
ZONE:
'Minimum Setback Distances: ` - ,• -
, _
Front Setback from Center Line
Rear Setback from Rear Prop. Line
' -
CONSTRUCTION LENDING AGENCY `'
Jid 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 -
* _
Side Street Setback from Center Line
- Side Setback from Property Line r.
Lenders Address
FINAL DATE INSPECTOR
-
' This is abuilding permit when properly filled out, signed and validated, and is subject to
expiration it work thereunder is suspended for 180 days.
I car Illy that 1 have read this application and state that the above information Is correct.
I agree'to comply withall 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.
Issued by: Date Permit- `
a
Validated,by:
Signature of applicant Date
Mailing Address
'Val idation:
City, State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST 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
FLOOR DRAIN
MECHANICAL FEES
HEATING (ROUGH)
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
DUCT WORK
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
HEATING (FINAL)
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
BOND BEAM
SO. FT. ®c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1% c
SEWAGE DISPOSAL
LUMBER GR.
SO.FT.GAR ® bLc
HOUSE SEWER
FRAMING
FINAL INSP.
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 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.
K ROOFING l q /
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
f f
GARDEN WALL FINAL