11343 (BLCK)` I •
Building, „y j
Address Rubio
Owner
MS . r Mary Rues
Mailing
Address
CityZip
Quinta 92253
Contractor
er-Building Co.
Address
( nryy
498
City / Zip
La Quinta 9.2253
P.O. BOX 1504 } t
7&105 CALLE ESTADO �~No. 11.343
�
LA QUINTA, CALIFORNIA 92253
BUILDING: TYPE CONST: OCC: GRP.
A.P. Number
Tel.
Legal Description '
Project Description
45.1.. o.f-. 5 r wood frame stucco wall
Tel.:
5614-2651
State Lic.
& Classif. - ' B506812
City
Lic. #
Sq. Ft.
No., No. Dw.
�j
Size
Stories -Units
Arch., Engr., , -
New ❑ Add ❑
Alter ❑ Repair ❑ Demolitiori.❑'
Designer
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
of Division 3, of th Business and Professions Code, and my license is in full force and
effect
. effect. ' • /.��An+.✓"w�" -
+
SIGNATURE - ? DATE
' OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License law for the following
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, poor to its issuance also
requires the applicant for such permit to rile a signed statement that he is licensed pursuant to
Me provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Didslon 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 -.
subjects the applicant to a civil penalty of not more than rive hundred dollars ($500).'
❑ I, as owner of the property, or my employees with wages as their sole compensation, wili
do the work, and the structure is not intended or offered for sale. (Sac. 7044, gess and
Professions Code: The Contractor's License Law does not apply -to an owner of property who
builds or improve -thereon and who does -such work himself or through his own employees,
provided, that- such improvements are not intended or offered for sale.: ff, -however, the building
Estimated.Valuation -
974.25 -
.. PERMIT
-
AMOUNT,
Plan Chk. Dep..
'
Plan Chk. Bal..
',.•�.
Const..
Mech.
'
' Electrical
-
or improvement Is sold within one year of completion, the owner -budder will have. the burden,y
of proving that he did not build or improve for the purpose of sale.)
Plumbing
-
O I, as owner of the property, am exclusively contracting with licensed contractors to con-
struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law
S.M.1.
• does not apply to an owner of property who builds or improves thereon, and who contracts for,
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
0Aam exempt under Sec. B. & P:C. for this reason -
Grading
-
Driveway Enc.
Date Owner
Infrastructure
2
WORKERS' COMPENSATION DECLARATION
' I hereby affirm that I have a certificate of consent to self -insure, or a certificate of
Worker's Compensation Insurance, ora certified copy thereof. (Sec. 3800; Labor Code.)
•' r y ,•�
Policy,No. .Company
Oscopy is filed with the city. . ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS'COMPENSATIONINSURANCE,
TOTAL
2711 i T 4
REMARKS
„
(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: If, after making this Certificate of Exemption you should become
subject to the Workers' -Compensation provisions of ,the Labor Code, -you must forthwith-
comply with such provisions or this permit shall be deemed revoked. -
ZONE:—• BY: - •• '
- -
k Minimum Setback Distances:
Front Setback from Center Line 1
Rear Setback from. Rear Prop: -Line '
- CONSTRUCTION LENDING AGENCY
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 Street Setback from Center Line
n
Side Setback from Property Line'
Lender's Name
-
FINAL DATE
Issued by:,-
- r
Validated by:
,
INSPECTOR
a
Date 0. Permit'
Lender's Address
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.
I agree to comply with all city and county ordinances and state laws relatingto building
construction, and hereby authorize representatives -of this city to enter the above-.
mentioned property for inspection purposes.
Signature of applicant 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. @
CARP. 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
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
LAUNDRY TRAY
AIR HANDLING UNIT CFM
HEATING (FINAL)
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET'
COMPRESSOR HP
POLE,TEM/PERM
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 @ 11% c
SEWAGE DISPOSAL
LUMBER GR.
SO.FT.GAR @ 3/ic
HOUSE SEWER
Q //��
FRAMING X t r
VV
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 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.
Q //��
FRAMING X t r
VV
FINAL INSP.
ROOFING
�.
REMARKS:
'
VENTILATION
FIRE ZONE ROOFING:
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
tj
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION L
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL