13696 (RER)4 14 "
P.O. BOX 1504
Building 53--125 Ave. aivargz 78-105 CALLE ESTADO
Address LA QUINTA, CALIFORNIA 92253
Owner Gerhard Haldman
Mailing
Address Same
City Zip Tel.
La Q' rota, CA 922.53 1
Contractor
DoDco Construction
A dped. t'OX 1012
Cj&y Quiiita, CA
Zip 92253
Tela
State Lic.
& Classif. B--1 397830
City
Lic. # 1375
Arch., -gr., Greg 13Utler _.
Designer
Addre s
i' ,iii. BOX 6
Tel.
CityZip
La Qginta, C�
92253
State
Lic. #
. _ G6ENSED;CONTRACTOR'S DECLARATI.ON-
under provisions-of-Chpter.9,(co`mmencing with Section
and Professions Co,de;'and my licenseis in full force and
OWNER -BUILDER DECLARATION
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
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 civil penalty of not more than five hundred dollars ($500).
O 1, as owner of the property, or my employees with wages as their sole compensation, will
do the work, and the structure is not intended or.offered for sale. (Sec. 7044, Buisness and
Professions Code: _The Contractor's License Law does not apply to an owner of property who
builds or improves thereon and who does such work himself or through his own employees,
provided that such improvements are not intended or offered for sale. If, however, the building
orimprovement is sold within one year. of completion, the owner -builder will have the burden
of proving that he did not build or improve for the purpose of sale.)
❑ 1, as owner of the property, am exclusively contracting with licensed contractors to con-
struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law
does not apply to an owner of property who builds or improves thereon, and who contracts for
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec. B. & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
I hereby a irm that I have a certificate of consent to self -insure, or a certificate of
Worker's Co ensation Insurance, or a certified copy thereof. (Sec. 3800, labor Code.)
Policy Company
Copy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION-FRO—M1
WORKERS' COMPENSATION -INSURANCE
r
(This section need not be completed if the p mit iskr onefhundred dollars($•7:00)'"valuation
or less.) _-.` / mss"
I certify that in the performanceof'thp workdfor which this permit is issued, I shall not
employ any person in any manner so as to come subject to,ttie Workers' Compensation
Laws of California.
Date Owner/
NOTICE TO APPLICANT:Af�ftetZ, tiakfh§ tWhi Certificate of Exemption you should become
subject to the Workprs`:�Compensation pro isions 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 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 sof this city to enter the -above-.
mentioned property for inspection purposes.
Signature of applicant Date
Mailing Address
City,. State, Zip
No. 13696
BUILDING: TYPE CONST. - OCC: GRP.
A.P. Number
,Legal Description -
Project Description
774--032-•--012
Lot 4 Block 179
Remodel
(�
Sy
Il
Sq. Ft. 1208
Size •
No'
Stories
No. Dw.
Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ -
�� 11
�%a'� = FY
Minimum Setback Distances: U"'"' `
k—
Front Setback from Center Line
..
sl
Rear Setback from Rear Prop. Line
Side Street Setback from Center
Line
Side Setback from Property Line
Estimated ValuationQ,4{s
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
318.33
Const.
382.00
Mech.
.28. 00'
Electrical
_.83 ' 78,.,
Plumbing
69.00
S.M.I.
4.50
Grading
Driveway Enc.
Infrastructure
TOTAL
'`\ 885.61
REMARKS
If
(�
Sy
Il
tiff,/ I+j
) f)
it {i1
ZONE: BY: If t A
�� 11
�%a'� = FY
Minimum Setback Distances: U"'"' `
k—
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
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
SLAB GRADE
r s
BONDING
YARD SPKLR SYSTEM
2ND FL. SQ. FT. p
FORMS
SEWER OR SEPTIC TANK
POR. SQ. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
HEATING (FINAL)
OTHER APPJEOUIP.
DRAINAGE PIPING
CAR P. SQ. FT.
TEMP. POLE
WALL SQ. FT.
GROUT
DRINKING FOUNTAIN.
SQ FT ®
FINAL INSP.
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER SYSTEM
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
FINAL INSP.
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
I
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, TEM/PERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER. B.T.U.
SQ. FT. ® c
BATH TUB
GAR. FIREWALL
SQ. FT. ®c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/3 c
SEWAGE DISPOSAL
SQ.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$-=$-
lusx$=$ROOFING
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
I
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL