RR (9819)P.O. BOX 1504 No. 9819
Building78-105 CALLE ESTADO
Address 52970 • p NL"iTc' aro LA QUINTA, CALIFORNIA 92253
Owner
YEr . Cohn
Mailing BUILDING: TYPE CONST. OCC. GRP.
Address t3 arae
A.P. Number
City Zip Tel.
La Quantic 92253 Legal Description
Contractor Project Description
C. V. Raofincs
Address '�G�^'Kts?Ci f
i'. Q. Bax 1256
City Zip Tel.:
Indio 922 2 398--5186
State Lic. City
& Classif. C39 352007 Lic. # 319 Sq. Ft. No. No. Dw.
Arch., Engr., Size Stories Units
Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address Tel.
CityZip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
it hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
000) of DijvisJhdr 3t/ofj)the. usi♦nesrs,�b_Profess/ions Code, and my license is. in -full force/and'
ffect. 1! 3e?�#. �.[ GGfil/Y 7-!l F
,5ATUR LATE '
11GN! OWNER&ILDER DECLARATION
I hereby affirm that I am exempt from the Contractors License Law for the following Estimated Valuation --2980.00
reason: (Sec. 7031.5,Business 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 we a signed statement that he is licensed pursuant to .. PERMIT AMOUNT
the provisions o/ the Contractor's License Law, Chapter 9 (commencing with Section 7000) of _
Division 3 of the Business and Prolessbns 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 perms Plan Chk. Dep.
subjects the applicant to a civil penalty o/ 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. .54.80
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 -
orimprovement 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 sale.) .
• ❑ I, as owner of the property, am exclusively contracting with licensed contractors to con. Plumbing c
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.I. .30
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
Grading.
❑ I am exempt under Sec. B. & P.C. foilhis reason •Y-
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 celtified•co�pyy thereof -(Sec. Labor Code.) -
Polic , No. %r Y o dL l r; a ��
Eftopy is filed with the city. m❑ Certified copy is hereby furnished. �. s A0 `r k ,oaf' y S `Y 11 ' �t '' ' ,� A :,'< '
TOTAL - 5 � ;� 0 _ _ _
CERTIFICATE OF EXEMPTION FROM REMARKS
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100) valuation
or less.) -
I certify that in the performance of the work for which thisipg�pnit is issued, I shall not
employ any person in any manner so as t me sub jegt two he Workers' Compensation
Laws IfyCalifornia 00
Dat *7
caner
NOTICE TO APPLICANT. h, after makfng this rtfftcate /'Exemption you should become
ZONE
,
BY:
subject''
coply with such provisions ormkepe,miitm1kiltshaalllbe deemed keds' code, you mast rorrnw/rn
---
Minimum_ Setback Distances: -
Front Setback from Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY
Side Street Setback from Centel 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.) _ vim•, •
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 f Date
Mailing Address «
Validation:
City, State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST 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
ROUGH PLUMB.
FLOOR DRAIN
MECHANICAL FEES
HEATING (ROUGH)
WATER SOFTENER
VENT SYSTEM. FAN tVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
DUCT WORK
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
GAS (ROUGH)
LAUNDRY TRAY
AIR HANDLING UNIT CFM
HEATING (FINAL)
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
BOND BEAM
SO. FT. @ c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID @ 1 Vi c
SEWAGE DISPOSAL
LUMBER GR.
SO.FT.GAR @ V4c
HOUSE SEWER
FRAMING
FINAL INSP.
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
cu. yd.
$ plus x$
=$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL