10776 (RR)4
P.O. BOX 1504 No. 10776
Building 49-797 Coachella Dr 78-105 CALLE ESTADO
Address LA QUINTA, CALIFORNIA 92253
Or
Vii,` . and mr►rs . Sha. ma
Mailing BUILDING: TYPE CONST. OCC: GRP.
Address same
A.P. Number
City Zip Tel.
Aja Quinti .92253 564--4403 Legal Description
Contractor Project Description
wraig Conklin Co. -,,--Roof
Address _
73-612 Hwy 111 47
-City Zip Tel.:
Pala Desert 1 92260 346.3805
State Lic. City
& Classif. $ 336634 Lic. # 203 Sq. Ft. No. No. Dw.
Size . Stories Units
Arch., Engr.,
Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address Tel.
City Zip State
• Lic. #
LICENSED CONTRAITOR'S DECLARATION
I hereby affirmthat'llam licensed under provisions of Chapter 9 (commencing. with Section
7000) of Division 3 of the B'usine'ss and Professions Code, and my license is in full force and
effect.
_SIGNATURE DATE _
OWNER-BUILDER DECLARATION Estimated VdlUatlOn
I hereby affirm that I am exempt from the Contractor's License Law for the following r ��
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 -PERMIT AMOUNT
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 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.
do the work, and the structure is not intended or offered for sale. (Sec: 7044, Buisness and Const. 20.00
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.
provided, that such improvements are not intended or offered for sale. lf, however, the building
or improvement is sold within one year of completion, the owner-builder will have the burden Electrical
of proving that he did not build or improve for the purpose of sale.)
0 I, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing
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. '
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
Grading
❑ 1 am exempt under Sec. B. 8 P.C. for this reason
Driveway Enc.
Date 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 i =
yLI Copy is filed with the city. ❑ Certified copy is hereby furnished. `
TOTAL 20.00
CERTIFICATE OF EXEMPTION FROM REMARKS
.WORKERS' COMPENSATION INSURANCE.
(This section need not be completed if the permit is for one hundred dollars ($100) valuation
orless.)
I certify that in the performance of tha work for which this permit is.issued, I shall not }, �0 , I ��„ f M :frJ
employ any person in any manner so as to become subject to the Workers' Compensation
Laws of California.
Date Owner '
NOTICE TO APPLICANT: It, 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
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 FINAL DATE INSPECTOR
This is a building permit when properly filled out, signed and validated, and is subject to
expirationif 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 Date
Mailing Address Validation:
City, State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
COLL. AREA
SLAB GRADE
YARD SPKLR SYSTEM
2ND FL. SQ. FT.
HEATING (ROUGH)
STORAGE TANK
FORMS
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
DUCT WORK
ROCK STORAGE
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
METER'LOOP
HEATING (FINAL)
DRAINAGE PIPING
CAR P. I SQ. FT.
GAS (FINAL)
WALL SQ. FT.
DRINKING FOUNTAIN.
SQ. FT. ®
URINAL
ESTIMATED CONSTRUCTION VALUATION $
FINAL INSP.
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
GRADING
cu. yd.
$, plus x$
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUT.0)(DISH)
APPLIANCE DRYER
FINAL INSP.
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR. SUSPENDED
LAUNDRY TRAY
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
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID-(1p-1'/cc
SEWAGE DISPOSAL
SQ.FT.GAR ® Vac
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
VENTILATION
REMARKS:
FIRE ZONE ROOFING:
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION' L/
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL