11317 (RER)f
r
P.O. BOX 1504
Building55-837 Con xess.- oral 7&105 CALLE ESTADO
AddresLA QUINTA, CALIFORNIA 92253
Owner,
Abigail Maxfield Wright
Mailing
Address same as above
City Zip Tel.
.Wa Quinta 9225.3 771--0709
Contractor
No. 11317
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number
Legal Description
Project Description
Replacing sliders and adding new
headers
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City'
Zip
Tel.:
-LCI
State Lic.
& Classif. 447983
City
Lic. # 1131
- -
Sq. Ft.
No.. No. Dw.
Size
Stories Units
Arch., Engr.,
Designer Flying Buttress
New ❑- Add ❑
Alter ❑ Repair ❑ -Demolition ❑
Address
• 79,301 Country Club
Tel.
772-3966
City-
Zip
State
Bermuda, Dunes
92201
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 Contractors 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
I for the alleged exemption.. Any violation of Section 7031.5 by 'any applicant for a permit
Is bjects 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
X the work, and the structure is not intended or offered for sate. (Sec. 7044, Buisness and '
Professions Code: The Contractor's License Law does not apply to an owner o1 property who
builds or improves thereon and who does such work himself or through his own employees,
provided that such Improvements are rot 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.)
Estimated Valuation
7,000
PERMIT -
AMOUNT
Plan Chk. Dep.
'Plan Chk. Bal.
. 5
Const.
90.00
Mech: -
'-
Electrical
Plumbing
❑ I, as owner of the property, am exclusively contracting with licensed contractors to cor"
Strutt 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
isuch projects with a contractor(s) licensed pursuant to the Contractor's License Law.) I
❑ 1 am exempt under Sec. B. & P.C. for this reason
•S.M-I.
.70
G'radind
Driveway Enc.
` J / f
Date` -4- r�-2•Ownery r� }j �t J�V� X'' "' ! ' - Il' f'7-
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
t .149.20
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
-_REMARKS
(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 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
a
Side Street Setback from Center Line
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 Setback from Property Line
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.
FINAL DATE
-•
Issued by: '
Validated by:
INSPECTOR
Date Permit
Signature of applicant Date`
Mailing Address
Validation:
City, State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
COLL. AREA
2ND FL. SO. FT.
YARD SPKLR SYSTEM
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
ROUGH WIRING
DUCT WORK
DRAINAGE PIPING
CAR P. SO. FT. ®
GAS (ROUGH)
WALL SO. FT.
HEATING (FINAL)
DRINKING FOUNTAIN.
SO FT ®
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.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GRADING .
cu. yd.
$ -Plus-x$-=$
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
FINAL INSP.
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
IBATH TUB
FIRE ZONE ROOFING
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
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.
FRAMING
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
/
NSPECTION
eMl- INSPECTION-
111
CERT.
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL