10788 (PLBG)ice• �f� � e 4.14
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Building 53-325 Rubio
Address
Owner
Mr/Mrs George Contreras
'Mailing ni
Address Santo_
City Zip ;
i,3 Qmin.ta 92253
Contractor
L. 'L. Wilson Construction
Address
P. O. Box 1587
P.O. BOX 1504 N o . ! U 18 B
78-105 CALLE ESTADO f
LA OUINTA, CALIFORNIA 92253
BUILDING: TYPECONST. OCC: GRP.
A.P. Number 774--G72--015
Legal Description
Project Description
Sewer. Book 'Up ,
CityZip;
Tel::
Indio
92201
342-2322
State Lic.
City
& Classif.52 319
Lic. #
Sq. Ft.
No. No. Dw.
Size
:, Stories • Units
Arch., Engr.,
Designer
New ❑ _ Add ❑
. ,' Alter ❑ Repair ❑ 'Demolition,❑ ,
Address
Tel.
V
City
Zip'.
State
Lic. #
r
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter '9 (commencing with Section
.7000) of Division 3 o,4ff the Business� and, Professions Code, and my license is in full force and
'.
..effect. �...�:�=Ku: Ls�w....�C �,i:�1 "
t•,
_
•SIGNATURE" •. - DATE
.. .....
. -
' OWNER•BUILDER DECLARATION
Estimated ValUatlOn
I hereby affirm that I am exempt from the Contractors License Lary for the following
5
reason: (Sec. 7031.5,Bustness and Professions Code: Any city or county whkh .regvaes a
`
I ,
'
permit to construct, after, improve, demolish, or repair any structure, prior to ft ssLence also
•• . j .
requires the applicant for such permit to rile a signed statement that hes licensed pursrsnt`to}_.
PERMIT '
- AMOUNT ..
.the provisions of the Contractor's License Law, Chapter 9 (commencbxg .wO Section • 7000) of
•
-�
Division 3 of the Business and Professions Code, or that. he is exempt therehom, and the basis
for the alleged exemption.. Any violation. of Section 7031.5 by -any for.
,,plan Chk. De p.
• applicant a pemd
subjects the applicant to a civil penalty of not more than rive hundred do9ars.($500).
Y 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 sate: (Sec. 7044,-Liidwessand
Const.,
- -
Professions Code: The Contractor's License Law does not appy 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. It, however, the buidng
or improvement is sold within one year of completion, the owner -builder wilt have the burden
-
Electrical
- -
,, of proving that he did not build or improve for the purpose of safe.)
❑ 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 Contractors License taw -
does not appy to an owner of property *who builds or improves thereon, and who contracts for
S.M.I. - -
-
- such projects with a contractors) licensed pursuant to the Contractors License Law-) ..
Grading .
❑ I am exempt under Sec B. t: P.C. for this reason
Driveway Enc.
Date Owner
Infrastructure '
WORKERS' COMPENSATION DECLARATION
'I hereby affirm that I have a- certificate of consent to serf -insure, or a certificate of
Workers Compensation. Insurance, or a certified copy thereof. (Sec. 3800, Labor Cade-)
- Policy No .Company
❑ Copy is filed with the city. ❑ Certified copy is hereby furnished.'
TOTAL
30.00
CERTIFICATE OF EXEMPTION FROM
REMARKS
~
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100) vaMetion
' ..
or less.) ..
I certify that in the performance of thg work for which this permit is issued, I shall not
;..IY r h^ ', to di f 1 n'@ A,�) +'..
t+_r +~ .s'. 4 , T?t�'�� )`�75�#t-; T?i 3 a 1 0
employ any person in any manner so as to become subject to the Workers' Compensation
Laws of California.
Date Owner
' - NOTICE TO APPLICANT: H, after making this Certificate of Exemption you sham become
ZONE:
' BY:-
• subject to the Workers' Compensation'. provislons 'of the Labor Code, you. must -forthwith
comply with such provisions or this permit shall be deemed revoked. ..
- •t•
Minimum Setback Distances: ' • ti.
Front Setback from Center Line
,.
Rear.Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY
Side Street Setback from Center Line
Ihereby 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 ,
Lenders Name
Lenders 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
Mailing Address
Validation:
City, State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SQ. FT. ® $
2ND FL. SQ. FT.
POR. SO. FT. ®
GAR. SQ. FT. ®
CAR P. Sp. FT.
WALL SO. FT. ®
Sp FT ®
ESTIMATED CONSTRUC–ION 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.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WA_L FLOOR SUSPENDED
OTHER APPJEOUIP.
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.
SO. FT. ® c
BATH TUB
FINAL INSP.
SO. FT. ®c
IWATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1% c-
SEWAGE DISPOSAL
SQ.FT.GAR ® 3Aac
HOUSE SEWER
VENTILATION
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE JELECT.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 O i"K
UGH WIRING.
DUCT WORK
ROCKSTORAGE
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.
FRAMING
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING:
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION- -/7
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL