9660 (RR)P.O. BOX 1504
zz� N o. 9660
Buildin ci _��
78-105 CALLE ESTADO
9 48-905 AVENIDA, FERNANDO
Address LA QUINTA, CALIFOR . NIA. 92253
Owner
DAIJ EDGAR BUILDING: TYPE CONST. REROOF OCC: GRP. -
Mailing
Address SAME A.P. Number
City Zip Tel.
LA QUINTA,CAI 92253 1 Legal Description
Contractor Project Description REROOFING ROCK ROOF (WITH
MCINTIRE ROOFING CO. INC. ROCK) (4590 SQ. FEET)
Address
43 612 N. JACKSON
city - Zip Tel.:
TNDIO 92201 342-1466
State Lic. City
& Classif. 601429 C-30 Lic.# 303 Sq. Ft. No. No. Dw.
Size Stories Units
Arch., Engr.,
Designer New 0 Add 0 Alter 0 Repair 0 -Demolition 0
Address Tel.
City Zip State
Lic. #
1__7 * LICENSED CONTRA5TOR'S DECLARATION
I hereby affirrfi_ttiat I am licenspP under provisions
'T �,J Chapter 9 (commencing with Section
7000),of Division 3 of the B s a;,d &S ode, and my license is in full force and
us'97
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 rile 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 applicant for a permit
subjects the applicant to a civilpenafty atnot more than five hundred dollars.($500).
0 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 safe. 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.)
b I, as owner of the property, am exclusively contracting with licensed contractors to con-
.tr..t 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' C t' I urgej, or4certifX'ddVyjJtT,0f. (Sec. 3800, Labor Code.)
VPolic SIT p� a
y N/6 .2133 A 3 — — .
0 Copy is filed with the city. 0 Certified copy.is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS'COMPENSATION INSURANCE
(This section need not be completed it the permit is for one hundred dollars ($100) valuation
or less.)
I certify that in the performance of thp work for which this permit is issued, I shall not
employ any Ferrn�lon in any manner,so as to become subject to the Workers' Compensation,
Laws of Call 0 a.
Date_Owner
NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should beco . me
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 affirm that there is a construction lending agency for the performance of. the
work ch this permit is issued. (Sec. 3097, Civil Code.)
Lender's Name
Lender's Addle
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 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 —Dat&_
Maili ' nq Address,
City, State, Zip
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Lin
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE —INSPECTOR
Issued by: —Date—Permit
Validated by:
Validation:
ut
Estimated Valuation
$14.609.97
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
$162.00
Mech.
Electrical
Plumbing
S.M.I.
L *.�Pu
Grading
Driveway Eric.
Infrastructure
TOTAL
L63. �W
REMARKS
_0()5j.,92 — 0 3 _77j j_
AV
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Lin
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE —INSPECTOR
Issued by: —Date—Permit
Validated by:
Validation:
ut
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. @ $
UNITS
COLL. AREA
2ND FL. SQ. FT. @
YARD SPKLR SYSTEM
I
POR. SO. FT. @ -
MOBILEHOME SVC.
-
BAR SINK
GAR. SO. FT. @
POWER OUTLET
ROOF DRAINS
CAR P. I SO. FT. @
DUCT WORK
DRAINAGE PIPING
WALL SO. FT. @
I
DRINKING FOUNTAIN.
SO. FT. @
HEATING (FINAL)
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
MATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
GRADING
cu.yd.
$_plus_x$_=$
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.
SO. FT. @ c
BATH TUB
SO. Fr. @ c
WATE A HEATER
MAX HEATER OUTPUT, B.T.U.
SO. FT. RESID @ 1 V4 c
SEWAGE DISPOSAL
SQ.FT.GAR @ V4c
HOUSE SEWER
SPARK ARRESTOR
GAS PIPING
PERMIT FEE
PERM FEE
PERMIT FEE
DBL
TOTAL FEES
I .
MICRO FEE
I I
MECH.FE!E EPLCK--FEE
-
CONST. FEE ELECT.FEE
I I
SMIFEE PLUMB. FEE
T
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
ROCKSTORAGE
FOUND. REINF.
GAS(ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
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 4
FINAL INSP. I
ROOFING
VENTILATIOi7
REMARKS:
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIFINITIALS.
GARDEN WALL FINAL
I
i