11228 (GRES)P.O. BOX 1504 / N O . 112 2 8
Building a2-334 Rubio78-105CALLEESTADO JJJ✓✓✓
Address LA QUINTA, CALIFORNIA 92253
Owner
Eric V. Burdon
Mailing BUILDING: TYPE CON OCC: GRP.
Address P. 0. Boy: 4336
A.P. Number
City Zip Tel.
Palm _cis 92263 324-1294 Legal Description
Contractor LJ $ CONSTRUCTION Project Description
naris f�d.ibT�iP .
AddressGarage a add window to bedroom
Cityfd �A ZiP 7 3 5 $
State Lic. {) City
& Classif.e Lic. # rr. d Sq. Ft. 400 No. No. Dw.
Arch., Engr., Size Stories Units
'
Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address Tel.
ZipIState
Lic. #
LICENSP CONTOACTOR'S DECLARATION
I hereby affirm that I artrt}} lice sed under provisions of Chapter 9 (commencing with Section
D00) of Division 3 of thEBu mess and Professions Code, and my license is in full force and
ffpcfx. syr' _ / . .4'
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! OWNER' -BUILDER DECLARATION
I hereby affirm that 11 am exempt from the Contractors Lirense Law for the following
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a
permit to construct, atter, improve, demolish, or repair any structure, . pdor to its issuance also
requires the applicant for such.permit to file a signed statement that he is licensed pursuant to
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Division 3 o/ the Business and Professions Code, or that. he is exempt theieefrom, and the basis
forthe 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 five hundred dollars ($500).
❑ 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
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,
provided that such improvements are not intended, or offered for sale. M, however, the building
or improvement is sold within one year of completion, the owner -builder will have the burden
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-
struct
the project. (Sec. 7044, Business and Professions Code: The Contractors License Law
does not apply to an owner of property who builds or improves thereon, and -who contracts for
.such projects with a contractors) licensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec. B. & P.C. for this reason
Date Owner
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
{ 3O Copy is filed with the city. ❑ Certified copy is hereby furnished.
l
CERTIFICATE OF EXEMPTION FROM
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 thg work for which this permit is issued, 1 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. '
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.)
Lenders Name
Lender's Address
This is a building permit when properly filled out, signed and validated, and is subject to
expiration it 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
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
4
FINAL DATE INSPECTOR
Issued by: Date Perm
Validated by:
Validat
Estimated Valuation .
7,440.00
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
64.35
Const.
99.00
Mech.
Electrical
Plumbing
S.M.I.
.80
Grading
Driveway Enc.
Infrastructure
TOTAL
154.15
REMARKS
46r,4tiL�Fr
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
4
FINAL DATE INSPECTOR
Issued by: Date Perm
Validated by:
Validat
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
2ND FL. SQ. FT.
POR. SQ. FT. ®
GAR. SQ. FT. ®
CAR P. 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
BONDING
FLOOR DRAIN
MECHANICAL FEES
FORMS'�
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APPJEQUIP.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
TEMP. POLE
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.
SQ. FT. ®c
BATH TUB
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 1% c
SEWAGE DISPOSAL
D /` �O � Q/n i1
lC QCL3 (/`y
SQ.FT.GAR ® 3/ic
HOUSE SEWER
VENTILATION
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. PL/O/ BING ELECTRICAL HEATING & AIR COND. SOLAR
Olt
SETBACK d
ND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE p,
V/VIROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS'�
SEWER OR SEPTIC TANK
ROUGH WIRING.
DUCT WORK
ROCK STORAGE
FOUND. REINF. ,S
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.
do
FRAMING
FINAL INSP ® 22
-1-
ROOFING 12 !i � �h
J
D /` �O � Q/n i1
lC QCL3 (/`y
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING C�
<9m PIAL CULP
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION-
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATUREWINITIALS
GARDEN WALL FINAL