10154 (CRES). ( T • 9
Building
Address
Owner
54-865 Rubio
Josephine Price
Address same
City lZip Tel.
Contractor
Owner/Builder
Address
Zip I Tel.:
P.O. BOX 1504 No. 1015=
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253 1
e. -
State Lic. I City
& Classif. Lic. #
Arch:; Engr., ;
of". ,Designer
,__Address Tel.
CityZip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of the Business and Professions Code, and my license is in full force and
effect.
_SIGNATURE 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, 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
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
7su jects the applicant to a civil penalty of not more Man live 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. g, however, the building
or improvement is sold within one year of completion, the owner -budder will have the -burden
o1 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 contractor(s) licensed pursuant to the Contractor's License Law.)
O 1 am exempt under Sec. B. & P.C. for this reason !
4
i 1 T Ir
Date Owner �t. > - . r f �✓
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 city. : O Certified copy is hereby fumished.
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 the work for'which this permit is".sued, I shall not
employ any person in any man er so as to become subject to. the Workers' Compensation -
Laws of California. �+ f 7 T f
Date owner! l f ff n
NOTICE TO APPLICANT: a er making this Certificate of Exemption'you should become
subject to the Workers' Compensation provisions of the LaborrCode, '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.)
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. :
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
I
LDING: TYPE CONST. OCC: GRP.
P. Number
Legal Description
Project Description
Adding Ear Por€.
Sq. Ft. 288
Size
No.
Stories
No. Dw.
Units
New ❑ Add ❑
Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
3, 772.80
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
40.35
Const.
63.00
Mech.
Electrical
Plumbing
S.M.I.
.40
Grading
Driveway Enc.
Infrastructure
TOTAL
Q 5
REMARKS
txfa i;`%3..r'.{}
SADW_ in—.^;. --r? � L�
Er �.` j.o ld,,i ii L
"v 1.YC19Ym. 'A .E.il" ♦Nt.a
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: Date Perm
Validated by:
Validati
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST 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
SLAB GRADE
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
SEWER OR SEPTIC TANK
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
DUCT WORK
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
WATER HEATER
MAX. HEATER OUTPUT, B.T.U..
SO. FT. RESID ® 1% c
SEWAGE DISPOSAL
BOND BEAM
SO.FT.GAR ® V4c
HOUSE SEWER
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 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.
D /
FRAMING / C (/In
[[[
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
�y
FINAL INSPECTION-)
t
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS.
GARDEN WALL FINAL
r
6
y �
Cf'y OF
OWNER -BUILDER VERIFICATION
Attention Property Owner::
An owner -builder permit.has been. applied for in your name and
bearing•your signature.
Please complete and return this information at your earliest
opportunity.to avoid unnecessary delay in processing and .issuing -
your building- permit.- No building permit will'be issued until
this verification is received.
1.' I personally plan to provide the major labor'an aterials for
construction of, the proposed•property improvement iye or no)
2. I have have .not) signed an application for a
building a for the proposed work.
3. I.have contracted with the following person (f=rm) 'to provide
the proposed construction:
Name
Address City
Phone. Contractors License No.
4. I plan to provide..portions.of the work, but I have hired the
following person \ocoordinate,.supervise and provide the major
work:
Name
Address City.
Phone Contractors License No..
5. I will proviXepome of the work but I have contracted (hired)
the following persons provide the work indicated: (see attached).
WNERP30ILDEM SIGNATURE