12120 (RPL)QUW
• P.O. BOX 1504
No. 12120
Building 78-105 CALLE ESTADO
Address 54-800 Rubio LA QUINTA, CALIFORNIA 92253
Owner
Roger L. Kringen
Mailing BUILDING: TYPE CONST. OCC: GRP.
Address 75-641 Camino De Paco
A.P. Number
CityJZip Tel.
Indian %ells � :A 52210 Legal Description
ContractorProject Description Pool
Team Builders
Address
79-600 Cortez
City Zip Tela
%a Quinta, CA 192253 564--0602
State Lic. City
& Classif. B 500239 Lic. # 2859 Sq. Ft. No. No. Dw.
Arch., Engr.,
Size Stories Units
Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address Tel.
31 side yard setback approved 93-175
City _ �Zip State
Lic. #
r
LICENSED CONTRACTOR'S,DECLARATION
I hereby affirm that Pam licensed under provisions cii,6apter 9 (commencing with Section
7000) of Division 3 of the Business and ProfessibnsyCode, and my license is in full force and
SIGNATUREDA
�" .✓✓�"/ TE
//OWNER -BUILDER DECLARATION' Estimated ValuationuAA AA
I hereby affirm that-( am exempt from the Contractors License Law for the following $, 000 f?0
reason: (Sec. 7031.5,Busihess and Professions Code: Any_city or county which requires a
permit to
thconstruct, alter, improve, demolish, or repair any structure, prior to its issuance also AMOUNT
requires e applicant for such permit to file a signed statement that he is licensed pursuant to PERMIT
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Division 3 of the Business and Professions Code, or thathe 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 five hundred dollars ($500).
O I, as owner of the property, or my employees with wages as their sole compensation, will Plan Chk. Bal. 64.35
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and Const. �� ��}
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. 2!�
provided that such improvements are not intended or offered for sale. If, however, the building 24.00
or improvement is sold within one year of completion, the owner -builder will have the burdenEI2CtrICal 45.00
of 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- Plumbing 27.00
struct 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 S. M. 1. • 90==
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
Grading
❑ I am exempt under Sec. B. & P.C. for this reason
Driveway Enc.
Date Owner Infrastructure
1
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.)
PolIe
ic NIO Company
Copy is filed with the city. ❑ Certified copy is hereby furnished.
TOTAL 260 • 15
CERTIFICATE OF EXEMPTION FROM REMARKS
WORKERS' COMPENSATION INSURANCE 1 w tt t
(This section need not be completed if the permit is for one hundred dollars ($100) valuation 1�;jam#_,��,, ifjrr•'�Q... f $`r� 7,ti ,„ , �., 1
or less.) t. i:' :+rtu.e x rc.. r.r� + ....0 •. a.:
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 ZONE: BY:
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith Minimum Setback Distances:
comply with such provisions or this permit shall be deemed revoked.
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
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 Dale
Mailing Address Validation:
City, State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES.
COLL. AREA
SLAB GRADE
!T
1ST FL. SQ. FT. ® $
UNITS
FORMS
r �y
(
DUCT WORK
ROCK STORAGE
2ND FL. SO. FT.
GAS (ROUGH) METER LOOP
YARD SPKLR SYSTEM
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SO. FT. ®
FINAL INSP.
DRAINAGE PIPING
WALL SQ. FT.
WATER SYSTEM
FINAL INSP. s
FINAL INSP.
DRINKING FOUNTAIN.
SQ. FT. ®
LUMBER GR.
URINAL
ESTIMATED CONSTRUCTION VALUATION $
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WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
VENTILATION
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FIREPLACE
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET'
COMPRESSOR HP
POLE, TEMIPERM
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 ® 11/4 c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ac
HOUSE SEWER
CERT. OCC.
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE [P!L.CK.FEEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
GROUND PLUMBING6'4-1UNDERGROUND, j
A.C. UNIT
COLL. AREA
SLAB GRADE
_
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.IEQUIP.
REINF. STEEL
GAS (FINAL) TEMP. POLE
GROUT
WATER HEATER SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
FINAL INSP. s
FINAL INSP.
GRADING
cu. yd.
$ Plus—X$—=$
LUMBER GR.
FRAMING
ROOFING
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REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION — –J
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL