10096 (RR)T4ht- u�c�cu
I
4
P.O. BOX 1504
Building 53-401 RaMirez 78-105 CALLE ESTADO
Address LA QUINTA, CALIFORNIA 92253
C.
Owner
Furtino and Agana :Maria Sanchez
BUILDING: TYPE CONST.
No. 10096
OCC: GRP
Mailing
Address 420 C6da; Avenue
A.P. Number
City-
Zip
Tel.
,Qs Angeles
94065
225-7026 95
Legal Description
Project Description
ai Re Roof
ContractorParti
Owner/Builder
Address
City
Zip
Tel.:
State Lic.
City
& Classif.
Lic. #
Sq. Ft.
No. No. Dw.
Size
Stories Units
Arch., Engr.,
Designer
New ❑ Add ❑
Alter ❑ Repair ❑ 'Demolition ❑
Address
Tel.
City
Zip
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 1 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 five hundred dollars.($500).
64 as owner of the property, or my employees with wages as their sole compensation, will
Estimated Valuation
�' 200
PERMIT
AMOUNT
Plan Chk. Dep.
.
Plan Chk. Bal.
Const.
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.) -
Mech.
Electrical
Plumbing
b I, as owner of the property, am exclusively contracting with licensed contractors to con-
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
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. '
*9 dn
.20
Grading
Driveway Enc.
Date 157--P"�% owne
Infrastructure
t
WORKERS' COMPENSATION DECLARATIONY
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. ❑ Certified copy is hereby furnished.
TOTAL
45.20
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one .hundred dollars (S 100) valuation"'
or less.)
I certify that in the performance of tho work for which this'p rmit is issued, I shall not
employ any person in any manner so asto become subject,to the Work rs' Compensation
� (�
awso Caynomi�D
D�h n
Date caner \ —
NOTICE TO APPLICANT: 1, aReVinaking this Certificate of -Exemption you should become
subject to the Workers' Compensation provisions of the Labor code, you o niusi forthwith
comply with such provisions or this permit shall be deemed revoked.
REMARKS i b t* l }�'1 a .F7 ti, f S 49-1.6-1411
ZONE:BY:
Minimum Setback Distances:
+
Front Setback from Center Line
Rear Setback from Rear Prop. 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.)
Side Street Setback from Center Line
Side.Setback from Property Line
Lender's Name
FINAL DATE
INSPECTOR
Lender's Address
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 stale 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
Signature of applicant Date
Mailing Address
Validation:
'
City, State, Zip
Kr
,
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
2ND FL. SQ. FT. ®
POR. SO. FT. ®
GAR. SQ, FT. ®
CAR P. SQ. FT. ®
WALL SO. FT. ®
SQ, 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
BONDING
FLOOR DRAIN
MECHANICAL FEES
-
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APPJEQUIP.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
IKITCHEN
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 Vi c
SEWAGE DISPOSAL
'
SO.FT.GAR ® Vic
HOUSE SEWER
REMARKS:
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 APPJEQUIP.
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
'
REMARKS:
VENTILATION
FIRE ZONE ROOFING:
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION -
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
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 thna`or labo erials for
construction of the proposed property improvem t ( e r no
2.; I. (have a� signed an application for a
building 'permit or the -proposed work.
3.` I.have contracted with the following person (firm) to provide
the proposed construction:
Name Mi<
Address 7 City �l�1� AA�L 3r1'
Phone Contractors License No.
4 I plan to`.'provide portions of the work, but I have hired the.
following person to coordinate, super ' e. and prcvi a the, major
work:
Name
Address Z -ity
Phone �''-� Z Contractors License.No.
5.' I will provide some of the work'but..I have cc,ntracted (hired)
the following persons.to provide the work indicates.:. (see attached)