003548 (BLCK)d IOU
f14
P.O. BOX 1504 No. 00354
Building. —Q�5 CSE O$f5� 78-105 CALLE ES.TADO
Address 50-4.7— i,& itJI, LA QUINTA, CALIFORNIA 92253
Owner
Bruce Eobinson BUILDING: TYPE CONST. -OCC: GRP.
Mailing
Address P, 0, Box 38 A.P. Number 769-073-003.
City Zip Tel.
14 Quinga 92253 564-628.2 Legal Description
Contractor 5* X1001 Of 'W �"B` ce
. Project Description
Address .
City JZip 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 '
70 OO) of Division 3 of the Business and Professions Code, and my license is in full force and
effect.
SIGNATURE DATE
OWNER -BUILDER DECLARATION
Estimated Valuation
I hereby affirm that I am exempt from the Contractor's -License Law for the following750�+%
reason: (Sec. 7031.5.Business and Professions Code: Any city or county which requires a
-to
'
permit construct, alter, improve, demolish, or repair any structure, prior, to its issuance also
-• requiresthe 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
'any
PlanChk. Dep.
for the alleged exemption. Any violation of Section 7031.5 -by applicant for a •permit
subjects the'applicant to a civil penalty of not'more than. five hundred dollars ($500).
"
Plan, Chk. Bal.
O 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. (Secr7044, Buisness and '
dor1St.
$20.00Professions
Code: The Contractor's License Law does not apply to an ownerof 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.). , .
-
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-
Plumbing
• strucl 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.I.
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) -
Grading
❑ lam exempt under Sec. • B. & P.C. for -this reason
Driveway Enc.
Date fo �' % 7 Owner i - --/ ^
InfrastFucture
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. ❑ Certified copy is hereby furnished.
TOTAL
7
CERTIFICATE OF EXEMPTION FROM
REMARKS
WORKERS' COMPENSATION INSURANCE
(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
1141 i W3. yy R7
--• employ any person in any manner so as to become subject to the Workers' Compensation
IV Lfi2,ti f'3 .I. I :1 t s:i_ :. h. c. v
Laws of California.
Date Owner
NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become
ZONE: -
BY:
subject to the . Workers' Compensation provisions of the Labor Code, you must' forthwith
Setback Distances:
comply with such provisions or this permit shall be deemed revoked
.Minimum
-
Front Setback from Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY
Side Street Setback from Center Line-
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 permitwhen 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.
ISSUed by:
Date 12'-129d 87 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-
ateMailing
MailingAddress
Validation:
City,. State, Zip
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
2ND FL. SO. FT.
POR. SO. FT. ®
GAR. SO. FT. ®
CARP. SO. FT.
WALL SO. 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.IEOUIP.
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
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
REMARKS:
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 APP.IEOUIP.
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
Un J a1UnN 1 U nCW 1M111NLJ,
GARDEN WALL FINAL