003035 (RR)Building
Address 5Im$40 DEW
Owner MS. $iVM
Mailing
Address
City JZIp
Contractor
P.O. BOX 1504
78.105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
P.O. WX 1256
X10 ZIp 92202 Tela 39$:5186
& Classif.. . C-39 352007
Arch., Engr., -
Designer _
Address
No. .003€35
BUILDING: TYPE CONST. OCC: GRP,
A.P. Number 77A.194. -M7
Legal Description
Project Description RE ROOF
Lic. # 319 Sq. Ft. No. No. Dw.
Size Stories Units
Tel.
CityZIp State
7Lic. #
LICENSED CONTRACTOR'S DECLARATION
I herebyy affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Dlvlelon 3 obthe Business and Professions Code, end my license la In full.force and
effect. f �r /� _1�11.�111 J
SIGNATURE DATE
OWNEWBUILDER DECLARATION +
I hereby affirm that I am exempt from the Contractor's License law for the following
reason: (Sec. 7031.8,Buslness and Professions Code: Any city or county which requires a
permit to construct, atter, Improve, demollsh, 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 Buslness'and Professions' Code, or that. he Is exempt therefrom, and the basis
for the alleged exemption. Any violation of Section 7031.8 by 'any applicant for, a permit
subjects the applicant to a civil penalty of not more than five hundred dollars ($800).
❑ 1, 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.)
0 1, 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.)
0 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 self -Insure, or a certificate of
Worker's Compensation Insurance, or a certified copydhereof. (Sec. 3800, Labor Code.)
Policy No. Company
❑ Copy. Is filed with the city. ❑ Certified copy Is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
.WORKERS' COMPENSATION INSURANCE
i (This section need not be completed If the permit Is for one hundred dollars ($100) valuation
l or less.) —
I certify that in the performance of the work for which this permit Is Issued, I shell not
employ any arson In any manner so as to become subject to the Workers' Compensation
I Laws of Cal Ifppornla.
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.
CONSTRUCTION LENDING AGENCY
I 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
HARD COPY
New ❑ Add ❑ Alter ❑ Repair:?
Demolition ❑
.REMARKS
Estimated Valuation
$1,.453.00
z -PERMIT-
AMOUNT
Plan'Chk. Dep.
BY:
T Plan Chk. Bal.
Const.
$25.00
Mach.
Electrical
Plumbing
FINAL DATE
S. M. 1.
.Issued by:
Grading
Validated by:
Driveway Enc.
Validation:
Infrastructure
A 7 7 0 8
4 8 _ 25,5G fl
TOTAL
.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:
Date4� 7 Permit
Validated by:
Validation:
A 7 7 0 8
4 8 _ 25,5G fl
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
A.C. UNIT
COLL. AREA
SLAB GRADE
YARD SPKLR SYSTEM
2ND FL. SQ. FT. ®
BONDING
HEATING (ROUGH)
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
ROUGH WIRING
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
FOUND. REINF.
GAS (ROUGH)
DRAINAGE PIPING
CAR P. SQ. FT. ®
HEATING (FINAL)
WALL SQ. FT.
REINF. STEEL
DRINKING FOUNTAIN
SQ FT ®
TEMP. POLE
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
FINAL INSP.
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LUMBER GR.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
FRAMING
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
FIRE ZONE ROOFING
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1114 c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ac
HOUSE SEWER
GAR. FIREWALL
GAS PIPING
PERMIT FEE
LATHING
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
T SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR GOND. 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.IEQUIP.
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
DEC
17
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS,
GARDEN WALL FINAL