002659 (RR)Atyl 4
P.O. BOX 1504
Building ' ` 78-105 CALLE ESTADO
Address �3s" s 'l1 8 ��� LA QUINTA, CALIFORNIA 92253
Owner
Designer
New Q Add ❑ ' Alter ❑. Repair ❑ _ Demolition ❑
Address
Mailing
Address
h
City
CityTip
Zip
Tel.
.. l t2igi
92253
Lic. #
Contractor
LICENSED CONTRACTOR'S DECLARATION.
hereby affirm that I am licensed under provisions of°Chapter 9 (commencing with Section .E
Address .
7000) of Division the Business and Professions Code; and my license is in full force and '
.
78--550 Darby Tbad
effect• �3;of
. City
.. ..Zip
..
Tel.: '
Ter 44
49 til
AI;-
State Lic.
F hereby affirm'that I am exempt from the Contractor's License Law for the. following
City
& Classif:274
921
Lic. # /;
BUILDING: TYPE CONST. OCC; GRP;-
A.P.
RP; A.P. Number
Legal.Description
Project Description
..o
-'girl
Sq. Ft. No. No. Dw.
Size Stories Units • •••
Arch.,-Engr:,
Designer
New Q Add ❑ ' Alter ❑. Repair ❑ _ Demolition ❑
Address
Tel.
CityTip
State
Lic. #
LICENSED CONTRACTOR'S DECLARATION.
hereby affirm that I am licensed under provisions of°Chapter 9 (commencing with Section .E
7000) of Division the Business and Professions Code; and my license is in full force and '
effect• �3;of
SIGNATURE c__ r ^r^- .. "c..•r. ev^w-"- DATE
OWNER -BUILDER DECLARATION
EStlmated ValUatlOn
F hereby affirm'that I am exempt from the Contractor's License Law for the. following
¢c' p� v
I 00
reason: Sec. 7031.5,Business and Professions Code: •Ancit ,or count which requires a
permit, to construct, alter, improve, demolish, or repair any structure, prior to its issuance also
•t9 •
+a
,requires the applicant. for 'such permit to rile a signed. statement that huts licensed pursuant to
-PERMIT"
- AMOUNT
the provisions o/ the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
-
Division 3 of the Business and Professions Code, or fha8 he 'is exempt therefrom: and the basis...
for the Any Section 7031.5 by 'any for.
Plan Chk. Dep. -
'
- '.
alleged exemption. violation of applicant a permit
' subjects the applicant to a civil penalty'ol not more than five hundred'dollars-($500)..
Plan Chk.. Bal.
.• .
❑ I, 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 "
Confit.
. 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.. 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 or 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
.does not apply to an owner of property .who builds or improves thereon, and who contracts for
S. M.1. -
a
- such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
Grading
❑ 1 am.exempt under Sec. B. & P.C. for this reason -
Driveway Enc.
Date Owner
Infrastructure
WORKERS' COMPENSATION DECLARATION
Thereby 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
O Copy is filed with the city. . ❑ Certified copy is hereby furnished.
TOTAL
a�i3
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 lhg work for which this permit is issued, I shall not
-employ any person in•anymannerso 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
BY:
' subject to the Workers' Compensation provisions of' Labor- Code, yomust forthwith
comply with such provisions or this permit shall be deemed revoked.
.ZONE:'
Minimum Setback Distances: '
Front Setback frcm Center Line
Rear Setback. from Rear Prop. Line
CONSTRUCTION LENDING AGENCY
Side Street SetbEck 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 fron Property Line
Lender's Name
• Lender's Address
'
FINAL DATE
IIJSPECTOR
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.
'. 'city
Issued by:
Date-- Permit
I agree to comply with all 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 purpose
Validated by:
Signature of applicantqfrf f_.. :Date a ^n ?
Mailin Address A�4�c '`� •� v
9. .. � `>
Validation:
City, State, Zip
'
A5597
1 29 ;L5�i [�
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
SLAB GRADE
2ND FL. SQ. FT. ®
BONDING
YARD SPKLR SYSTEM
POR. SQ. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
CARP. SQ. FT. ®
GAS (ROUGH)
DRAINAGE PIPING
WALL SQ. FT. ®
OTHER APP./EQUIP.
DRINKING FOUNTAIN
SQ. FT. ®
TEMP. POLE
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GROUT
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
BOND BEAM
WATER SYSTEM
FLOOR DRAIN
MECHANICAL FEES
=$
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
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
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11A c
SEWAGE DISPOSAL
LATHING
SQ.FT.GAR ® 3/ac
HOUSE SEWER
MESH
GAS PIPING
PERMIT FEE
INSULATION/SOUND
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./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
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION /v 3
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS,
GARDEN WALL FINAL
Proposal Proposal No.
FROM Custom Roofing Company Sheet No.
78 550 Derby Road
Indio,California 92201 Date Oct.28,1986
34.5-3751
Proposal Submitted To Work To Be Performed At
Name
Wm. Barnes Street
Street City State
CityZa Qt» nta Date of Plans
State C -a l i f o rn i s Architect
Telephone Number 564-6610
We hereby propose to furnish all the materials and perform all the labor necessary for the completion of
Clean roof off and re -roof com-plete house using,new ++;fetal on edges,
1 laver 75 lb. glass base sheet nailed on and 2 lavers glass ply,
hot mopped,crushed rock and coated white.
Five 5 ,year gurantee on leaks.
All material is guaranteed to be as specified, and the above work to be performed in accordance wi$r the drawings and specifications
submitted for above work and completed in a substantial workmanlike manner for the sum of
Dollars ($1880.00 ).
with payments to be made as follows:
In full upon completion of roofing.
Any alteration or deviation from above specifications involving extra costs, will be executed only upon written orders, and will
become an extra charge over and above the estimate. All agreements contingent upon strikes, accidents or delays beyond our
control. Owner to carry fire, tornado and other necessary insurance upon above work. Work -men's Compensation and Public
Liability Insurance on above work to betaken out by Custom Roofing, Company
"NOTICE TO OWNER"
(Section 7019—Contractors License law)
Under the Mechanics' Lien Law, any contractor, subcontractor,
laborer, materialman or other person who helps tD improve your Paul Williams
and is not paid for his labor, services or material, has a Respectfully submitted
right to enforce his claim against your property.
Under the law, you may protect yourself against such claims by
filing, before commencing such work or Improvement, an ori�'nal Per Custom Roof J_ng Co ;pany
contract for the work of Improvement or a modification thereof, in
the office of the county recorder of the county where the property
Is situated and requiring that a contractor's payment bond be recorded
In such office. Said bond shall be In an amount not less than fifty 274 921
percent (50%) of the contract price and shall, In addition to any State License No.
conditions for the performance of the contract, be conditioned for phone--- 3,; 5— J �Sl
the payment in full of the claims of all persons furnishing labor, sere•
ices, equipment or materials for the work described in said contract.
Note — This proposal may be withdrawn by us if not accepted within days
ACCEPTANCE OF PROPOSAL
The above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as
specified. Payment will be made as outlined above.
Accepted Signature
Date
Signature
Contractors are required by law to be licensed and regulated by the Contractor's State license
Board. Any questions concerning a contractor may be referred to the Registrar,. Contractors State
License Board, 13132 Bradshaw Roadj Sacramento, California. [Mailing Address: P.O. Box
26000, Sacramento, California 95826.]
TOPC FARM �AKn _ - .
LITHO IN U. S. A.