13807 (PLBG)Building
Address
Own r
Tit,
f4le
r,.'. P.O. BOX 1504 _ No.
51-78W' 'Ave � Rubio 78-105 CALLE ESTADO
LA.QUINTA, CALIFORNIA 92253
e Fir. Calvin Davis
Mailing
Address Same
City Zip - Tel.
gra .Quinta CAA; 92253
Contractor
Hendrickson Construction,, Ind.
ess
Addr
,1.
BUILDING: TYPE CONST. OCC: GRP
A.P. Number
Legal Description
Project Description '�Sg Connect
YES Kieley Road'
City ZipT I.'
Cathedral City , Chi 9.22.34 i619? 328-1747
State Lic. A 654167 City 194
& Classif. Lic, # Sq. Ft.
Arch* Engr ...._ Size.
No. '
Storie
13807
No. Dw. L,
Units
Designer
New ❑ Add ❑
''Alter ❑ Repair ❑ Demolitiori ❑
Address
Tel.
' City '.
Zip
State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
`
I hereby affirmtthat I am licensed under Proyisions of Chapter 9 (commencing with Section
' 7000) of DivisioJn,3 of�the Business ro.�fcessions
-,an ode, and my license is iq full force and
- effect.
_.
JT/`�'d� >. PrrY'�.° .d,!«••C�--�
1GNATURE >`/' DATE
y 'OWNER•BUILDER DECLARATION
I hereby that I from the Contractor's
Estimated V81UatI0n '
��gg �•
642: VAA
$ 0
affirm am exempt License Law for the following
reason: (Sec.• 7031.5,Business and Professions Code: Any city or county which requires a
i
'
permit to construct, alter, improve, demolish, or repair any structure, prior *to its issuance also
requires the applicant for such permit to lila a signed statement that 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 7031.5 'any for
Plan Chk. Dep.
-
violation of by applicant a permit
subjects the applicant to a civil penalty of not more than five hundred dollars.($500). -
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.
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. j
'
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
30.00
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.) Z!
_
Grading
-
❑ 1 am exempt under Sec. B. & P.C. for this reason
Driveway Enc.
:
Date Owner
Infrastructurer
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
O Copy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
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 the 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
subject to the- Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions'or this permit shall be deemed revoked.
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.)
Lender's Name
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 relating to building
construction, and hereby authorize representatives ',of this city to enter the above-.
mentioned property for inspection purposes.
Signature of applicant Date
Mailing Address
City, State, Zip
.OU
11tMHF11�J
• r
ZONE: BY:
Minimum Setback Distances:}
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
I�'• � i.
FINAL DATE INSPECTORIS
l
Issued by: Date +`,Pe�rrmit V ~`
Validated -by: L~ / t�y 09
i9
Validation: `9Q ;, r
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
SLAB GRADE
a
BONDING
YARD SPKLR SYSTEM
2ND FL. SQ. FT. @
FORMS
SEWER
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
GAS (ROUGH)
METER LOOP
GAR. SO. FT. @
POWER OUTLET
ROOF DRAINS
GAS (FINAL)
TEMP. POLE
DRAINAGE PIPING
CAR P. I SQ. FT.
GROUT
WATER HEATER
WALL - SQ. FT.
FINAL INSP.
DRINKING FOUNTAIN
SQ. FT. ®
WATER SYSTEM
URINAL
ESTIMATED CONSTRUCTION VALUATION $
=$
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
VENTILATION
LAUNDRY TRAY
AIR HANDLING UNIT CFM
FIRE ZONE ROOFING
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
LATHING
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID a 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ac
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 COND. SOLAR
SETBACK
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER
ROUGH WIRING
DUCTWORK
ROCKSTORAGE
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 SIGNATURESIINITIALS
GARDEN WALL FINAL