PLBG (11932)52350 Avenida Madero
11932
V,
P.O. BOX 1504
•78-105 CALLE ESTADO
Addrdess ' 52 -35Q'. Nader® LA QUINTA, CALIFORNIA 92253
Owner
Mr. Brian Vackers-
Mailing - -
Address SaMe
- City A Zip Tel.
No.' 11932 .:Y.
BUILDING- TYPE CONST. OCC. GRP. -<
A.P. Number 773--242--009
raiAiilta, Cks `.253
_
Legal Description
Project Description
Sewer — Yicai n>'i
y:
Contractor+
Hendric' kson Co t3uotfofi
Address
68-»315 Kie20ad
City
zip .•
Tel.
tCathedr l Ef !
.g223
328-1747
,.
State Lic.
City
`
& Classif.
Lic. # 194 '
Sq. Ft.
No. = No. Dw.
Size
r
Stories >~ Units
7
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Arch., Engr.;
New ❑ Add ❑
Alter ❑ ," Repair ❑
_
Demolition;❑' 'y =
A Y
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Designer . rg. =. ' " '
7w n
Address 'j,'-A^s. '`- •
Tel.
City 3i,
Zip's +
State
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Lic. #
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LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provjsjons of Chapter 9 (commencing with Section
' 7000) of Division 3 the Bu siyn e'ss stuns
oft a/nd ProI Code, and my license}'s iin./full1V9rce and
• SIGNATURE - -^+• s .n i DATE
OWNER -BUILDER DECLARATION !
1 I hereby affirm that I am exemptfrom the Contractor's License Law for the following
Estimated Valuation
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t Vs
reason: (Sec..7031.5,Business and Prolessfons Code: Any city or county which requGes a
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permit to construct, alter, improve, demolish,',or repair any structure,1prior torits issuance also
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,requires the applicant for such permit to file 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
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Division 3 of the Business and Professions Code, or that. he is exempt therefrom, and the basis,
for the Any Section 7031.5 'any
Plan Chk. Dep.
. alleged exemption. violation of by applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars (5500).
i
Plan Chk•
❑ I, as owner of the property, or my employees with wages as their sole compensation, will
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Const.
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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,
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provided that' such improvements 'are not intended or offered for sale. If, however, the building
.
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lectrical-❑
Electrical-
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 purposeof sale.)
-Plumbing
30.00 -
0I, 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
S. M. 1. -
• '
^ does not apply to an owner of property who builds or improves thereon, and who contracts /or
such projects with a contractors) licensed pursuant to the Contractor's License Law.)
Grading
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❑ 1 am exempt under Sec. B. & P.C. for this reason
Driveway Enc.
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-
> Date Owner
Infrastructure
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tr.
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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. ', O Certified copy is hereby furnished.
,
TOTAL
CERTIFICATE OF EXEMPTION FROM
IREMARKS
'
WORKERS' COMPENSATION INSURANCE
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n 'e. 1' •'
(This section need not be completed if the permit is for one hundred dollars •(3100) valuation
or less.) •t• -
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certify that in the performance of the work for which this permit is issued, I shall not
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urs - . r e
employ any person in any manner so as to become subject to the Workers' Compensation
i •
;
Laws of California.
Date Owner
NOTICE TO APPLICANT: If, alter 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 provisions or this permit shall be deemed revoked. ,
Minimum Setback Distances:
"
Front Setback from Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY
Side Street Setback from Center Line
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
DATE
INSPECTOR
Lender's AddressFINAL
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.
a
I CrlifyIhat 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 sof this city to enter the above-.
'mentioned property for inspection purposes.
r. -
Validated by:
..
Signature of applicant Date i+
• Mailing Address
,Validation:
City, State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
2ND FL. SQ. FT.
FORMS
YARD SPKLR SYSTEM
POR. SQ. FT. @
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SQ. FT.
OTHER APP./EQUIP.
DRAINAGE PIPING
WALL SQ. FT.
TEMP. POLE
DRINKING FOUNTAIN,
SQ 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
=$
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L 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.
SO. FT. ® c
BATH TUB
SPARK ARRESTOR
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 1+/a c
SEWAGE DISPOSAL
LATHING
SQ.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 4Ft5EfiY6-iAIJ1L
OUGH 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