11079 (BLCK)s
Building
Address 53-460 RUBIO
Owner
. DWAYNR BURKRt
Mailing
Address SAME
CLA Zip QUINTA 2253
Contractor .
HAMILTON MASONRY
Address,
P 0 BOK 1771
~ CLA QUINTA 9p2253
4
P.O. BOX 1504 No. 11079-
78-105
+079_7&105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253 '
Tel.
564-1799
BUILDINGc TYPE CONST: OCC: GRP. - "
A.P. Number
Legal Description
Project Description BLOCK WALL .22' K 6' .
State Lia
City
& Classif.59$584
Lic. # ' 1631
Sq. Ft.
No. No. Dw.'
Size •
Stories Units
' '-Arch., Engr.,
Designer
New ❑' . Add•❑
Alter ❑ Repair ❑ Demolition ❑
Address
Tel.
City
Zip
State
_.
-
_
Lic. #
, CTOR'S DECLARATION''
_ LICENSED COON.T• jr,
I hereby affirm that I arn'licepseyund" er gr,"oyysiions of Chapter 9 (commencing with Section
V 7000C'of Division 3 oi`theA�/sfness and P i�ssion Code, and my license "s in full orce a
SLGNA E '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, alter, improve, demofish, or repair any structure, prior to its Issuance also
requires the applicant for such permit to lfile a signed statement that he is licensed pursuant to
the provisions of the. Contractor's License Law, Chapter9 (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 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).
- 0 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 fhaf 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
of proving that he did not. build of improve for the purpose of sale.) , ,
Estimated Valuation
'
. PERMIT
..
.. r
• AMOUNT
Plan.Chk. Dep.
-
Plan Chk. Bal.
Const.
SS l.
Mech.
EIBCtrICBI
-
-Plumbing
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-
-- struct the project. (Seca 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
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec. B. & P.C: for this reason
S.M.I.-
' • b U
Grading
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
Copy -is filed with the ci ..
ty. • 17 Certified copy is hereby furnished..
i � . .. -
�;t,. !' 'i
n r w x lea
�TNr..+ W 0 •OI � 6�.5—Ac "" 2
- a a -� • a
TOTAL
;
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE •..
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: -
Minimum Setback Distances: r '
_
Front Setback from Center 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.)
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
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.
FINAL DATE
INSPECTOR
I certify that 1 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.
Issued by:
Validated by:
Date Permit
, y •
Signature of applicant Date'
Mailing Address
Validation:
City, State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. ® $
2ND FL. SO. FT. ®
POR. SO. FT. ®
GAR. SO. FT. ®
CAR P. 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 ® 1 Va c
SEWAGE DISPOSAL
LUMBER GR.
SO.FT.GAR ® 3/ac
HOUSE SEWER
FRAMING
FINAL INSP.
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 APP./EOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUTS1
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
�^ L�%
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 l
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL