9491 (BLCK)P.O. BOX 1504 No. 9491
Building 51-120 Rubio 78-105 CALLE ESTADO •���"'
Address LA QUINTA, CALIFORNIA 92253
Owner
,la Clayb rn
Mailing BUILDING: TYPE CONST. '� OCC: GRP.
•
Address 203$ N. �ed�nar
A.P. Number •
City Zip T"_
,
Upland. 917$65 Legal Description
Contractor Project Description "64 cedar f 6nce
Better Building Company
Address _
78-725 Lu Fonaa 41
CityZip Tel.:
La Ouinta 922.3 564-7651
State Lic. City
&Classif.' B 506812 Lic.# 1423 Sq. Ft. 110 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) of Divisio 3 f the Business and Professions Code, and my license is in full force and
f act. 1 a
G�TDgE '� DATE
OWNER -BUILDER DECLARATION
Estimated VdIU3tlOn
I hereby affirm that I am exempt. from the Contractors License Law for the following
$935.00
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires. a
permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance also
'.;•'requires the applicant for such permit to the a signed statementthat he is licensed pursuant to
- PERMIT' - - AMOUNT' '
' 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 Section 7031.5by'any
Plan Chk. Dep.
violation of applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars.(8500).
Plan Chk. Bal.
. ❑ I, 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
Const. 2.5 �Q
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
or improvement 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
strucl the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law
' E does not apply to an owner of property who builds or improves thereon, and who contracts for. -
S. M. 1. q n'
such projects with a contractors) licensed pursuant to the Contractor's License Law.)
-
Grading
❑ I am exempt under Sec. B.'8 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 No. Company '
❑ Copy is filed with the city. ❑ Certified copy is hereby furnished.
TOTAL 25. 10
CERTIFICATE OF EXEMPTION FROM
REMARKS
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars (S100) valuation
or less.)
I certify that in the performance of the work for which this permit is issued, I shall not
employ any parson in any mann r so to become subject,40 the Workers' Compensation
Laws of California. j� ��
(�T
�� i 3 ry w
rt a„_ 3
Date • Owner ..�-2� 1�.tlel!5
NOTICE TO APPLICANT: If, aRervmaJJrrr gds Ce )hcate o xemption you should -'become
r .'i"� 1 _•
...v r a s r ta. IV
ZONE: - BY:
subject to the workers' Compensatreni 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
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.)
Side Setback from Property Line It "
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 ' Date
Mailing Address
Validation: -
_
City, State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SQ. FT. ® $
2ND FL. SQ. FT.
POR. SO. FT. ®
GAR. SO, FT. ®
CAR P. I SQ. FT.
WALL SO. 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
ROUGH PLUMB.
FLOOR DRAIN
MECHANICAL FEES
HEATING (ROUGH)
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
ROCK STORAGE
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
OTHER APPJEQUIP.
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
WATER SYSTEM
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/. c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/4c
HOUSE SEWER
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 GOND. 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
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 SIGNATURESHNITIALS
GARDEN WALL FINAL