10741 (AR). T
4tyl 4.fwQg«rw
Addrdess 77-942 Lago Drive
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253.
Owner
Mr. and Mrs. Ed Waschka
Mailing
Address same
City Zip Tel.
La. Q�ziz� a 92253
Contractor -
T.A. Kennedy Construction
Address
No. 10741
NG: TYPE CONST. OCC: GRP._
P. Number
Description
t Description Room Addition
77350 Arroba
-
City - '
Zip
Tel.:
La Cuinta
92253
564--4660
State Lic.
City
& Classif. 442110
Lic. # 469
Sq. Ft. 228 • 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 1 am licensed under provisions of Chapter 9 (commencing with Section .,
7000) of Division 3 of the Business and Professions Code, and my license is in full force and
effect.
-
SIGNATURE DATE
OWNER -BUILDER DECLARATION
ion
Estimated Valuation
I hereby affirm that 1 am exempt from the Contractors License Law for the following
reason: 7031.5,Busiless Code: Any •
% 42
(Sec. and Professions city or county which requires a
permit to construct, after, improve, demolish, or repair any structure, prior to its issuance also
r �.
i.
requires- the applicant for such permit to file a signed statement that he is licensed pursuant to • ~
PERMIT t AMOUNT.
the provisions of the Contractors 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 Any Section 7031.5 'any•appfrcant
-
Plan Chk. Dep.
exemption. violation of by -for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars.($500).
❑ I,
-
Plan Chk. Bal. 87.75
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
Professions The Contractor's
Const. `^ � 35 ��
Code: License Law does not appy to an owner of property who
builds or improves thereon and who does such work himself or through his own emproyees,
that imrprovements.are
Mech. ►' " �i tf.A/�
- 15.00
provided such not intended or offered for sale. g, however, the building
or improvement is sold within one year of completion, the owner -builder will have the burden
Electrical 25.00
'
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 ,
struct the project (Sec. 7044, Business and Professions Code: The Contractor's License Law
does not apply to an owner of propertywho builds or improves thereon, and who contracts for
S.M,I. 1
ti 20 -
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
.
Grading
❑ I am exempt under Sec B. S P.C. for this reason
Driveway Enc.
Date l flownei�.._�%'P �'Z.-'t—mss.'..
Infrastructure
WORKERS' COMPENSATION DECLARATION
, s • r
I hereby affirm'that l have a certificate of consent to self -insure, or a certificate of
Workers Compensation Insurance, ora certified•copythereof. (Sec. 3800, Labor Code.)
(ilk #1 7 r( , s'1C .,•ti�f') n{ ;
Policy.No. Company
❑Copy
4 V
is filed with the city. ❑ Certified copy is hereby furnished.
TOTAL 2-63.95
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 person in any manner so as to become subject to the Workers' Compensation
Laws of California.
Date Owner
NOTICE TO APPLICANT: ll, 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 provfsbns 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
Ihereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Seo. 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. SO. FT. ® $
2ND FL. SQ. FT.
POR. SQ. FT. ®
GAR. SQ. FT. ®
CARP. SQ. FT.
WALL SQ. FT. ®
SQ 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
LAUNDRYTRAY
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.
SQ. FT. ® c
BATH TUB
BOND BEAM
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 1% c
SEWAGE DISPOSAL
LUMBER GR.
SO.FT.GAR ® VAc
HOUSE SEWER
FRAMING / t3151-2-
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 l PLUMBING ELECTRICAL HEATING a 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 APPJEQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
or
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
_$
LUMBER GR.
FINAL INSP.
FRAMING / t3151-2-
FINAL INSP.
ROOFING '�(� � J /
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Y
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
THING qZ
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION-/
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
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