15249 (RR)4 ,f - .
R.,
P.O. Box soa
No. i52
Building,' 78-495 CALLE TAMPICO
Address'.' 51--565 Ave. Rubio LA QUINTA, CALIFORNIA 92253
Owner BennettBUILDING: TYPE CONST - - OCC:,GRP:
Mailing
Address Sarah A.P. Number
City Zip
Legal Description •
Contractor l� r6gb
Euiytom . Rogff2 Project. Description
Address
39-986. Ra-nCho LOS Coyotes
CitIndio, .CA zip 92203 Tel345-375 •:
State Lic. City
& Classif:.° 625038. C-39 Lic. #
Arch.- Engr.,'
Designer ••
Address Tel.
Sq. Ft. : No. - No. Dw.
Size •Stories• Units
New ❑
Add O`'r' Alter O
Repair ❑ Demolition p
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 Divviisiow3 of the Business and'Profeseions Code, and my license is in full force and
•{effect. ' r�.w.C,r•Tsft"�/'±..:, _ -
f SIGNATURE-:' DATEOWNER-BUILDER DECLARATION
DECLARATION
hl ereby affirm that I am exempt from the Contractors License Law for the following Estimated Valuation 5i
reason: (Sec.,. 7031.5,Business and Professions Code: Any city. or county which requires a - 43 V 7 a AQ
permit to construct, atter, Improve, demolish, or repair any structure, prior to its issuance also ; -
requires the applicant for such permit to rite a signed statement that he is licensed pursuant to PERMIT ,y>!; - 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 violation of Section 7031.5 by 'any applicant for a permit , Plan Chk. Dep: - r
subjects the applicant to a civil penalty of 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 CDnst. 30.00 '
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.), _
O I, 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 property who builds or improves thereon, and who contracts for- S. M. 1. ! -
such projects with a contractors) (sensed pursuant to the Contractor's License Law.) -
❑ 1 am exempt under Sec. B. & P.C. for this reason Grading
_ �' a • Driveway Enc.
Date 44�02FOwner 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 C de.) _
Policy No. , Company�sid�'I4 ./?s. p
Vopy is filed with the city. ❑ Certified copy is hereby furnished. �•
TOTAL 30. 00
CERTIFICATE OF EXEMPTION FROM REMARKS
WORKERS'COMPENSATIONINSURANCE
(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 Califora.
i •- �.r _
Date U/&Owner
NOTICE 47-0APPLICANT:_, 1l,;after making this Certificate of Exemption you should become ZONE: BY: '
subject to the Workers' Compensewn 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
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND Side Street Seth' Center Line "
SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE j�
HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST. OF COMPENSATION, Side Setback frljfrj Prope �i'R
DAMAGES AS PROVIDED FOR' IN SECTION 3708 OF THE LABOR CODE, INTEREST,. AND. - • ;
ATTORNEY'S FEES.
This is A building permit when properly'filled out, signed and'validated, and is subject to FINAL DATE SPECTOR
expiration it work thereunder is suspended for,180 days: A/ /
I certify that I have read this.appllcation and state that•the above information is correct: Issued b •Dae ' rY fPefmlt `
1 agree to comply with all city and county ordinances and state'laws.relatingto.•building - y .. ��, r �+�' I(")n
construction, and hereby authorize representatives .bf this city to .enter the -above 1 ej; JS'
mantioned property for inspection_ purposes. • Validated by:
Signature of applicant / Date 47/
ks
Mailing Address _ ValldatlOn:
City, State, Zip - - -
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING. FEES
IST FL. SO. FT. ® $
UNITS
SLAB GRADE
2ND FL. SO. FT.
BONDING
YARD SPKLR SYSTEM
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SO. FT.
GAS (ROUGH)
DRAINAGE PIPING
WALL SO. FT.
OTHER APP./EOUIP.
DRINKING FOUNTAIN
SO. FT. ®
TEMP. POLE
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GROUT
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
A
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
FINAL INSP.
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
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
SPARK ARRESTOR
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/. c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ic
HOUSE SEWER
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
ROCKSTORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP./EOUIP.
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
AV
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL 71
38-980 RANCHO LOS COYOTES Sheet:
INDIO CA 92203
PHONE: (619) 345-3751 Date: JUNE 9, 1995
To: MR BENNETT Phone N0: ( RM 318
Address: 51-565 AVE RUBIO, LA QUINTA CA 92253
Job Address: 51-565 AVE RUBIO, LA QUINTA CA
SPECIFICATION AND UNDERSTANDING
Tear off existing roof and re -roof using 1 layer base sheet, 2 layers
fiberglass felt, hot mopped, and small crushed brown rock. Custom Roofing
Company responsible for clean up and removal of roofing debris from property.
NEW CONSTRUCTION FLAT ROOF: General Contractor or builder is responsible for
proper water drainage or taper.
SPECIAL INSTRUCTIONS AND NOTES: (1.) Any sheeting needed will be an extra
charge of $30.00 per sheet above contract price. (2.) A down payment may be
required to cover cost of material.
NOTES: IN KEEPING WITH INDUSTRY STANDARDS:
(1.) This guarantee does not cover any damage to the interior or exterior on
which the roof is applied or damage to any contents therein. This guarantee
does not cover damage to roof due to any cause beyond our control including,
but not limited to, fire, lightning, windstorm, hailstorm, installation of
antennas or other equipment, foot traffic on roof, structural fault or
settlement, cracking or other failure of roof deck, walls or foundation of the
building on which the roof is applied. (2.) Should it become necessary for the
roofing contractor to remove and/or reinstall any antennas, cooling or heating
appliances or other equipment, whether or not an additional charge is made for
such work, customer understands that neither Custom Roofing Company, nor
installer assumes any responsibility for the performance of said equipment.
(3.) Custom Roofing Company does not assume any responsibility for existing
code violations or for the.repair of any .existing defects unless specified in
estimate and proposal.
100% Five (5) year guarantee against leaks on Custom Roofing Company's.work.
TOTAL COST $3,075.00 PLUS COST OF SHEETING IF NEEDED.
TERMS: PAID ON COMPLETION OF WORK DONE BY CUSTOM ROOFING COMPANY UNLESS
OTHERWISE SPECIFIED IN THE CONTRACT.
If not accepted within thirty (30) days this proposal is null and void.
JOB TO BE STARTED IN A TIMELY MANNER ACCORDING TO SCHEDULE AND WEATHER
CONDITIONS.
ACCEPTANCE: You are hereby authorized to furnish all contents written in
contract to complete work mentioned in the proposal and contract for which
I/we agree to pay the amount mentioned, in said proposal, and according to the
terms thereof.
INSTALLATION: It is understood that by the acceptance of this proposal you
authorize Custom Roofing Company to make the installation, to issue work order
with specifications shown herein and to pay our charge for such installation.
You agree to pay Custom Roofing Company the amount specified herein, which
will cover the price of said materials and labor charges. This estimate is
based on complete job and any surplus material remains the property of Custom
Roofing Company. Verbal understanding and agreements with representatives
shall not be binding unless set forth herein. There shall be no liabilities
for delays in, or failure to complete, deliver or installation of all or any
of the herein mentioned merchandise, if due to fire, strikes, war,
governmental regulations, or any cause beyond our control. Any changes.made by
you in specifications herein, necessitating additional materials or labor
shall not be included or covered by this proposal, but shall be provided for
under separate and additional order from you.
OWNER'S SIGNATURE DATE: