11405 (RR)Building
Address
Owner
1
uu�,tc�
P.O. BOX 1504 �)
78-105 CALLE ESTADO
I-075 Rosarita LA QUINTA, CALIFORNIA 92253
U
Mailing
Address Same
City I Zip ITel.
Contractor
Petronella Roofing
Address
65-320 Kieley Ad.
City JZip Tel.:
1.
State Lia City r ��
8 Classif.460 707, Lic.#
Arch., Engr.,
Designer
Address Tel.
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I herebyyraffum tF�at°I am licensed under provisions'6ff'Chapter 9 (commencing with Section
7000)iof I,ivisyo¢n> of the Bugines�,and ProfessioisrCode, and my license is in full force and
No. 11405
JILDING: TYPE CONST. OCC: GRP.
P. Number
:gal Description
oject Description " . Re—Roof
Sq. Ft.
Size
New ❑
OWNER -BUILDER DECLARATION Estimated 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 or. county which requires" a
No. No. Dw.
1300- Stories Units
Add ❑ Alter ❑ Repair ❑ Demolition ❑
permit to construct, alter, improve, demoksh, or repay 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
for the alleged exemption. Any violation of Section 7031.5 by 'any applicantfor a permit
-
PERMIT
Plan •Chk.-Dep.
subjects the applicant to a civil penalty of not more than five hundred dollars ($500).
Plan Chk. Bal.
❑ 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
Const.
Professions Code: The Contractor's License Law does not, apply to an owner,ol 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. If, 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.) ,
O 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
S.M.1.
does not apply to an owner of property who builds or improves thereon, and who contracts for
such projects with a contractors) licensed pursuant to the Contractor's License Law.) -
Grading
❑ 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 copy thereof. (Sec. 3800, Labor Code.).
Policy No Company
191Copy is filed with the city. ❑ Certified copy is hereby furnished: .
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100) valuation
or less:)
1 certify that in the performance of thg work for which this permit is issued, I shall not
employ anyperson 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.
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.)
Lender's Name
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 state that the above information is correct.
I agree'to comply with all city andcountyordinances 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
Driveway Enc.
Infrastructure
TOTAL
.AMOUNT
30.00
REMARKS, "
30.00
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: Date Permit
w
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
2ND FL. SQ. FT. @
POR. SQ, FT, ®
GAR. SQ. FT. ®
CAR P. S0. FT. ®
WALL SQ. FT. ®
SO. 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
FORMS
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APP./EQUIP.
LAUNDRYTRAY
AIR HANDLING UNIT CFM
TEMP. POLE
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
BATH TUB
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ac
HOUSE SEWER
REMARKS:
j
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
I
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
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./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 Z} 4 G
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION-0j—
NSPECTION 0l—CERT.
CERT.OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL