14949 (RR):Building
Y P.O. BOX 1504
78-495 CALLE TAMPICO
J4-440 Ave. Rubio LA QUINTA, CALIFORNIA 92253
La Quinta Palms Realty
BUILDING: TYPE CONST. • OCC: GRP.
Mailing
Address P.O. .OX 3$6
City
Zip
Tel.
,asxi�ata,
9223
S&—iia
Contractor
Nelson Roofing Co.
.Address .. . _ i ..
675 American Ave.
Ieaumont, CA
Zip $22223
Tel.341-'9450
State tic. C zg51672$
City 265
& Classif. •
Lic. #
' Arch., Engr.,
Designer
Address
Tel.
City
Zip
State
Lic. #
�ecfect.
hereby affirm that I am li'ceed under provisions
f Chapter 9 (c mmencAg with Section
of Division 3of theZusinessandProfessioon , bde, and myticense"IS11h full force and
- yr ` - ..- j
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, after, improve, demolish, or repair any structure, prior to its issuance also
requires the applicant for such permit to rile 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 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 rive 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. 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 or improve for the purpose of sale.) .
b I, as owner of the property, am exclusively contracting with licensed contractors to con-
struct
onstruct 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
such projects with a contractor(s) (lcensed 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 IN'
Worker's
cilia certificate of
Worker's"Cp� pen�ation'I syrance, or a certified copy thereof. (S-ec. 3800/Labor Code.)
Policy�'o. "Ifs apr�P> Companyll�
Copy is filed with the city. ❑ Certified copy is hereby furnished.!
CERTIFICATE OF EXEMPTION FROM
WORKERS'COMPENSATIONINSURANCE
(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 anyperson 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.
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND
SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE
HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION,
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND
ATTORNEY'S FEES.
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
No. 14949
A.P. Number
Legal Description
Project Description �'eroo
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
FINAL DATE INSPECTOR
Issued by
Validated
Validatior
Sq. Ft.
Size
No.
Stories
No. Dw.
Units
New ❑ Add'❑
Alter ❑
Repair ❑ - Demolition ❑
Estimated Valuationi
$3t920.00
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Cfik. Bal.
Const.
30.00
,Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
30.00
REMARKS
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
FINAL DATE INSPECTOR
Issued by
Validated
Validatior
CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES
IST FL. SO. FT. ® $
2ND FL. SO. FT.
POR. SO. FT. ®
GAR. SO. FT. ®
CAR P. I 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
COLL. AREA
FLOOR DRAIN
MECHANICAL FEES
BONDING
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
DUCT WORK
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
GAS (ROUGH)
LAUNDRYTRAY
AIR HANDLING UNIT CFM
OTHER APP.IEOUIP.
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
GRADING
Cu. yd.
$ -Plus-X$-=$
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
FINAL INSP.
SO.FT.GAR ® 3/ac
HOUSE SEWER
REMARKS:
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
P7
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 OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP.IEOUIP.
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.
ROOFINGA�A�
REMARKS:
VENTILATION
Jj
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL
ti The
Ne Is 0 n 1:
oofing.
0MP any
State Contractors License # C39-516729
P.O. Box 584
Palm Desert, CA 92261
'(619) 341-9450
,�zt=t;:•t , .. '�IIi" s73Y^i`vs�';�., �'_s;t,. -t.-�.s, ogr,.'�:�+��
G =k Q
Name of Owner 7'
D
Job Address J 1/
Residence AdcjFess
City of
Telephone
On or in the building at the above job address, THE NELSON ROOFING COMPANY, agrees to furnish and install
the following materials and guarantees to do the work, in a workmanlike manner in accordance with standard practices,
accordina to the following specifications.
Any work done at the request of the -owners and not specifically listed he' in`will be �:harged for as ari ext a :-"
The owner(s) agree to pay for the above work completed as specified:
Cash Price $ 5, ',when due
Terms: $
Financing: time payments of
paid. First payment shall comr
amount to be financed.
consecutive months until fully
-- after completion. .
The undersigned represents that -Fie is (they are) the owner(s) of the above-mentioned premises and that the legal title thereto
stands on record in his (or their) name(s) and that he (or they) are of legal age.
The owners acknowledge receipt of a true copy of this contract and, that they have read and know the contents thereof; and that
the same contains the entire contract, and understood that no other agreement, verbal or written. is binding upon the parties
thereto. Time for completion is subject to delays caused by strikes, lockouts, weather or any other condition beyond the control of
the contractor. The company Is not responsible for any interior or household damage caused by Ve execution of this contract.
itis further agreed and understood that in the event of cancellation of this contract by the purchaser prior to start of work for any
reason whatsoever that the contractor Is to receive 25% of the total sales price as liquidated darn4ges and not as a penalty.
If this contract is assigned, or the work subcontracted, the assignee or subcontractor shall not be responsible accept for that
which is expressly written on the face of this contract.
Acceptance by you shall constitute our contract subject to approval or credit.
ACCEPTED:19
Owner
By -
Dealer Dealer