12267 (PLBG)52125 Avenida Rubio
12267
T.
P.O. BOX 1504 No. 12,2"
Building :x ^'12 .Rubio LA QUINTA78-105 CCALIFORNIA92253
Address • - •
Owner Mr a ' '&, ,Mrs. • Thomas Affewi'
Mailing
Address
City Zip Tel.
1►a Yt E ;..,,CA 92253
Contractor
Handrick4on Construction, Inc:
Address '
68. 315 lxWiley Road
City Zip Tel
t;athed r 1 `4 t 922.3 328-1747.
BUILDING: TYPE CONST. OCC. GRP.
A.P. Number
Legal Description
. r.
Project Description1. $fi d@rE 'Z`oInnidct +
State Lic
Classif 2Z$
City
I&
Sq. Ft.
Size
No. No. Dw.
Stories Units
Arch.,
Designer, , ;ti,
New ❑ Add ❑
Alter ❑ Repair ❑ Demolition ❑,
'AddressF
TeL
CityZip
+ t;
State
Lic. # '
'
LICENSED CONTRACTOR'S DECLARATION
"
I hereby affirm that I am licensed under prov'wons of Chapter 9 (commencing with Section
' 7000) of Division 3 of the B"u slgVss•aniJ ProfB mons Code, and my license is in full force and
effect. //A f
SIGNATURE'7 DATE
OWNER•BUILDERDECLARATION I
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 orlcounty 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 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 five 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, Bussness andC011St.
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 or completion, the owner -builder will have the burden
of proving that he did.not build or improve for the purpose of sale.)
Estimated Valuation $2,175.00
y '
PERMIT -
AMOUNT
Plan Chk. Dep:
Plan Chk. Bal.
,
Mech. .. -
Electrical -
Plumbing
1 n
d I ('j}
.
❑ l, -as owner of the property, am exclusively contracting with licensed contractors to con-
Strutt the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law
.$, M. I.
-
,.
-
,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.)
'
am
- O 1 exempt under Sec: B. & P.C. for this reason
Grading
Driveway Enc.
w
Dale ' 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 city. . O Certified copy is hereby furnished.
TOTAL
30.00
•1t CERTIFICATE OF EXEMPTION FROM
WORKERS'COMPENSATIONINSURANCE
REMARKS
- } • t
(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: '
-
Front Setback from Center Line
+
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY
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.)
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
Side Street Setback from Center Line
Side Setback from.Property Line _
Y ' INSP OR
• 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.
Issued by:
Validated by:
Date .Permit
SEP'l 3 1993 t
Signature of applicant Date
Mailing Address
Validation:
Dy
City, Zip
,State,
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
2ND FL. SQ. FT.
FORMS
YARD SPKLR SYSTEM
POR. SQ. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SQ. FT.
OTHER APP./EQUIP.
DRAINAGE PIPING
WALL SQ. FT.
TEMP. POLE
DRINKING FOUNTAIN
SQ FT ®
GROUT
URINAL
ESTIMATED CONSTRUCTION VALUATION $
FINAL INSP.
WATER PIPING
NOTE: Not to be used as property tax valuation
WATER SYSTEM
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
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.
SQ. FT. ® c
BATH TUB
SPARK ARRESTOR
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 1'/a c
SEWAGE DISPOSAL
LATHING
SQ.FT.GAR ® 3/ac
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
T".,.,
SEWER 0"'
OUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP./EQUIP.
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
r
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
I N SU LATI ONISOU N D
FINISH GRADING
FINAL INSPECTION. C> (
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL'' '