11179 (PLBG)r ,
P.O. BOX 1504 N o . 1117`9
Building 46"925 H1�21c12d Pa1Tt�SLAQUINTA
Address CALIFORNIA 92253
Owner
Mr/Mrs Norman Vaughan'
Mailing BUILDING: -TYPE CONST: OCC: GRP.
Address raFlme
A.P. Number -617-061-004
City Zip Tel.
L Quinta'I: 92253 Legal Description
Contractor Project Description
HENDRICKSON CONSTRUCTION
Address _ Seger Hook Up
68.315 Kieley Road
' 'CityZip Tel.:
Gat. Clt.y 92239 32x;3-1797
State Lic. City
& Classif. 256184 Lic. # 199 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) ofDi iision 3 of the Business and Professions Code and ifo1_ce and
mY license Fs in -full ,r -•
SLGNATURE - DATE
OWNEWBUILDER DECLARATION Estimated Valuation '
I hereby affirm that I am exempt from the Contractors License Law for the following
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which repines a 2410.00
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
Me 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 applicard for a perm - • Plan Chk. Dep. -
subjects the applicant to a civil penalty of not more than five hundred dollars ($500).
❑ 1, as owner of the property, or my employees with.wa es 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.
Code: The Contractor's License Law does not apply to an owner of properly who
builds or improves thereon and who does such work himself or through his own employees, Mech - - .
provided Nat such improvements are not intended or offered for sale. Il, however, the building
or improvement is sold within one year of completion, the owner-butder will have the burden Electrical
of proving that he did not build or improve for the purpose of sale.)
❑ 1, as owner of the property, am exclusively contracting with licensed contractors -to con- Plumbing 3 a Q
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.
such projects with a contractor(s) 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. o .Company Rig ttxr tom.. f j !«•.w.
❑�opy is filed with the city. ❑ Certified copy is hereby furnished. �''� kY Fr f f ? !. #
'�
TOTAL Ju U
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 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 Cali
fomia
Date Owner
NOTICE TO APPLICANT: If, 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 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
1 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
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. SQ. FT. ® $
UNITS
SLAB GRADE
2ND FL. SQ. FT.
BONDING
YARD SPKLR SYSTEM
POR. SQ. FT. ®
MOBILEHOME SVC.
BAR SINK -
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. I SQ. FT.
GAS (ROUGH)
DRAINAGE PIPING
WALL SQ. FT.
OTHER APPJEOUIP.
DRINKING FOUNTAIN.
SQ FT ®
TEMP. POLE
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GROUT
WATER PIPING
NOTE: Not to be used as property tax valuation
-
FLOOR DRAIN
MECHANICAL FEES
WATER SYSTEM
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER '
FINAL INSP.
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
r
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.
SQ. FT. RESID ® 1+/a c
SEWAGE DISPOSAL
GAR. FIREWALL
SQ.FT.GAR ® 3/ac
HOUSE SEWER
LATHING
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
CSEWER
OUGH WIRING.
kf
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
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL