06596 (RR)T4ht.4
4
P.O. 4 BOX 150 N 0. 4 iJ
Building 78-105 CALLE ESTADO
Address 53--124 Navarro LA QUINTA, CALIFORNIA 92253
Owner
Mailing
Stan Vie BUILDING: TYPE CONST. OCC: GRP.
Address A.P. Number 774-065.019
CityZip Tel.
.. Legal Description
Contractor
Re -roof
C. V. Roofing
Project Description
Address
P. 0. Box 1256 ,
City Zip Tela
ladin 1201 398-5186
State Lic.
City
& Classif.352007Lic.
#
Sq. Ft.
No. No. Dw.
Size Size
Stories Units
Arch., Eng
• Designer 'T -
New ❑ Add ❑
Alter ❑ Repair ❑ Demolition ❑
Address
Tel.
City
Zip
State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that 1 am licensed under provisions of'Chapter 9 (commencing with Section
7000) of Division 3 of the Business Professiioons'Code,
and and my license is in full force and
. effect. r ✓ .. r ,""" .. _ r� , r.
SIGNATURE - - DATE
OWNEWBUILDER DECLARATION
Estimated Valuation
I hereby affirm that I am' exempt from the Contractors License Law for the following
reason: (Sec. 7031.5,Bushness and Professions Code: Any city or county which requires a
permit to construct, atter, knpmve, demolish, or repair any structure, prior to its issuance also
requires the applicant for such pemnit to file a signed statement that he is licensed pursuant to
PERMIT
AMOUNT
the provisions or the Contractor's License Law, Chapter 9 (commenting with Section 7000) of
Divfsfon 3 of the Business and Professions Cafe, or that. he is exempt therefrom, and the basis
for the alleged exemption. Any Section 7031.5 by 'any for
Plan Chk. Dep.
violation of applicant a permit
subjects the applicant to a civil penally of 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
COnSt.
$63.00
Professions Code: The Contractor's. License Law.dees not apply to an owner of property who
builds or inpmves thereon and who does such work himself or through his own employees,
Mech.
provided Mat such urrprovements are not intended or offered for sale. 11, however, the building
orimprovement is sold within one year or completion. the owner -builder wig have the burden
Electrical
of proving that he did not build or improve for the purpose of sale.)
❑. 1, as owner of the property, am exclusively contracting with licensed contractors to con-
Plumbing
struct the project. (Sec. 7044, Business and Professions Coder The Contractor's License Law
does not apply to an owner of property who builds or brrproves thereon, and who contracts for
S.M.I.
such projects with a contractor(s) licensed pursuant to Ore Contractor's License Law.)
•_2$
Grading
❑ I am exempt under Sec B. 8 P.C. for this reason
Driveway Enc.
Date owner
Infrastructure
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self -insure, or a certificate of
Workers Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No Cornpany
❑ Copy is filed with the city. ❑ 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 (S100) valuation
or less.)
I certify that in the performance of the work for which this permit is issued, I shall not
employ any personnia in any manner so as to become subject to the Workers' Compensation
Laws of Califor
Date Owner
NOTICE TO APPLICANT: ff, after making this Certificate or Exemption you should become
sutljecl to the workers' Compensation provsions or the Labor Code, you must forthwith
amply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
1hereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, Civil Code.)
Lenders Name
Lenders Address
This is a building permit when property 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 applicationand 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 Date'
Mailing Address
City,. State, Zip
TOTALS
RFMARKC
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback fron Property Line
FINAL DATE INSPECTOR
Issued by:Datilal•%24/89Permit
Validated by:
Vaiidation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
SLAB GRADE
2ND FL. SO. FT.
BONDING
YARD SPKLR SYSTEM
POR SO FT ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SO. FT.
GAS (ROUGH)
DRAINAGE PIPING
WALL SO. FT.
OTHER APPJEOUIP.
DRINKING FOUNTAIN.
SO FT ®
TEMP. POLE
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GROUT
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SYSTEM
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FINAL INSP.
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
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.
SO. FT. ® c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
GAR. FIREWALL
SO.FT.GAR ® 3/ac
HOUSE SEWER
LATHING
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$
_$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESlINITIALS
'
GARDEN WALL FINAL