11297 (RER)• b7tr(t4
P.O. BOX 1504 N Q . 11297
Building 78-105 CALLE ESTADO '
Address 52-404 Rubio LA QUINTA, CALIFORNIA 92253 �
Owner y��'�f./
]'sr�18eI DallyBUILDING: TYPE CONST. OCC: GRP.
Mailing
Address same
. A.P. Number.
City Zip Tel.
La (_)-dinta 92253 Legal Description
Contractor Project Description Re—Plodel
T. A. Xennedy Cdn;tr€ 6tion
Address.
77350 Calle d rroba
City Zip Tel.:,
La Qu nta 92253 564-4660
State Lic. City
& Classif. 442118 B Lic.# 469 Sq. Ft. No. No. Dw.
Size Stories Units
Arch., Engr.;
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
ry7000) of Division 3 of the Business and Professions Code; and my license is in full force and
SIGNATURE U DATE "
OWNER-BUILDER DECLARATION Estimated.Valuation
I hereby affirm that I am exempt from the Contractors License Law for the following. 640.00
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a T..
permit to construct, atter, improve, demolish, or repair any structure, prior to its issuance. also -
requires the applicant for such permit to file 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) or
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.
subjects the applicant to a civil penalty of not more than rive hundred dollars ($500).
O I, as owner of the property, or my employees with wages as their sole compensation, will Plan Chk. Bal. 13-4.55
do the work, and the structure is not intended or offered for safe. (Sec. 7044, Buisness and Const. 0-7.00
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. ff, 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 bnprove for the purpose of sale.)
❑ 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 A
does not apply to an owner of property-who builds or improves. thereon, and who contracts for S.M.I. 2.00
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
Grading
❑ 1 am exempt under Sec B. &.P C. forthis reason-
f 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
07Copy is filed with the city.. ❑ Certified copy is hereby furnished. .
TOTAL 343.55
CERTIFICATE OF EXEMPTION FROM REMARKS
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 thF work for which this permit is issued, I shall-not ;,1�-:;•.t q#h(-{.L; f;.r fr;:,;+.; •:e„ O`gh- airs`;? --
employ any person in any manner so as to become subject to the Workers' Compensation - - - - --- --
Laws of California
Date Owner
NOTICE TO APPLICANT: fl, after making this Certificate of .Exemption youshould become ZONE: BY:
subject to the Workers' Compensation 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 Liffe
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
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
Malling Address Validation:
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 APPJEOUIP.
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
WATER SYSTEM
WATER SOFTENER
VENT SYSTEM. FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
FINAL INSP. t� P
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
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
SO. FT. ®c
IWATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® IVi c
SEWAGE DISPOSAL
GAR. FIREWALL
SO.FT.GAR ® Wic
HOUSE SEWER
LILAJ
THING 14
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PLCK.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 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. t� P
FRAMING0/ho/41 w
FINAL INSP. /�a/ /n
N/
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LILAJ
THING 14
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION- ' /l
t
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL