PLBG (10845)52640 Avenida Martinez
10845
44
P.O. BOX 1504 No. 10845
Building 52-640 Martinez78-105 CALLE ESTADO
Address LA QUINTA, CALIFORNIA 92253
Owner
Boyd G. Newbold
BUILDING: TYPE CONST: OCC: GRP.
Mailing
Address 2368 Foothill Lars
A.P. Number
agrca ZIp92621 Ti•14/990-052 of 18 Block 143
Legal Description m
Contractor It Y Project Description S-dwnr Hook Up
Address
City Zip Tel.:
State Lic. City
& Classif. Lic. # 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) t. of Division 3 of the Business and Professions Code, and my license is in full force and
effec- •
_SIGNATURE DATE
OWNER -BUILDER DECLARATION eq Estimated Valuation R
I hereby affirm that I am exempt from the Contractors License Law for the following QL
reason" (Sec 7031 5 Business and Professions Code" Any city or count- which r ulres a -
permit to construct, atter, improve, demolish, or repair any structure, prior to its issuance also
requires the applicant for such permit to We 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 doom ($500).
AAI, as owner of the property, or my employees with wages as their sole compensation, will
Id. the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and
Code:. The Contractor's License Law does not apply to an owner or property who
PERMIT
-
Plan Chk. Dep.
plan Chk.. Bal.
Const.
Mech. .
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 safe. N, however, the building
or improvement is sold within one year of compfation, the owner -builder will have the burden
of proving that he did not build or improve for the purpose of safe.)
Electrical'
Plumbing
OI, 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 or property ,who builds or improves thereon, and who contracts for
- such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec._______B.-.& P.C. for this reason ! t
S.M.I.
Grading
Driveway Enc.
DateEfH,j- Owners •rr ? ' ,tri ,- = ii I J
Infrastructure
WORKERS' COMPENSATION DECLARATION
Date Permit
u
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
CERTIFICATE OF EXEMPTION FROM REMARKS
WORKERS' COMPENSATION INSURANCE. '
or ess.j coon need not be completed i/ the perm } is for one hundred dogars ($100) valva o
I certify that in the performance of thVi w(. c for, which this
h s permit is issued, I shall,not
employ any person in any mannerso as to,becomeSsubject1to the Workers' Compensation
Laws of California. , } t t.1 f
Date . . aOwner , <T , c ; ire /' ! .. %'{ . f
NOTICE TO APPLICANT:\"ager making this Ceitiricate 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.
Signature of applicant Date
Mailing Address
City, State, Zip
AMOUNT
30.00
ZONE:
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
Issued by:
Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FLUS
IST FL SO. FT. ® $
2ND FL SO. FT.
FOR. SO. FT. ®
GAR. SO. FT. ®
CAR P. SO. FT.
WALL S0. 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
BONDING
FLOOR DRAIN
MECHANICAL FEES
FORMS
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APPJEGUIP.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
TEMP. POLE
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
FINAL INSP.
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1+/. c
SEWAGE DISPOSAL
SO.FT.GAR ® V4c
HOUSE SEWER
VENTILATION
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 APPJEGUIP.
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. '7'�
/
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION -
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINMALS
GARDEN WALL FINAL :d