11440 (RR)Building
JJdi53-895 Cortez
♦ ng
Gordon Okabashi
Mailing
a�
Address
City, Zip Tel.
.:a Quiata 92253
Contrac of
B I � 1 T�lOi3tra to
74075 Astor
4 4
P.O. BOX 1504 r` 'a--
7&105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
92260 1 341-6073
&Classjf. C39 636394 1Lic-#
Tel.
City IZip I State
Lic. #
I LICENSED CONTRA&TOR'8 DECLARATION
eb affirm that licensed and r rovisions ofChapter 9 (commencing with Section
of ilsloi,3 Busl`newt _ ions Code; -and my'license is in full force and
OWNER -BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractor's License Law for the following
reason; (Sec. 7031.5,8uscness and Professions Code: Any city or county which requires a
Permit to construct, after, implore, demo8sh,.or repair any structure, prior to Its issuance also
requires the appftcant • for such permit to fab a sighed statement that he is licensed pursuant to
Me
prodskuna o/ the Contractor's License Law, Chapter g (commencing with section 7000) of
Dtvlslon 3 of the Buskmas and Professions Code. or that. he Is exempt. therefrom, and dile basis
for the alleged exempftan. Any violation of Secftorn '7031.5 by 'any acoant for a pennif
subjects the applleant coca cleft pastry o/not. more Nan five hundred Mars (5500).
CTI, 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.eale. (Sec. 7044; Sulaness and
Professions Code: The Contractor's License Law does not appy to an owner of property who
builds or improves thereon and who acres such work himself or through his •own sml*yess,
provided Nat such &Wrovements are not Intended or offered for sale. n howeve , Ne D np
or Improvement is add within oae year of completion, the owner -builder ivl0 have me burden
of proving that he did not, build or Improve for Nepurpose of sale.) .
❑ I, as owner of the property, am exclusively contracting. with licensed contractors to coo-
-struct the project. (Sec. 7044, Business and Professions Code:.The Contractor's License Law
does not appy to an owner of property ,who builds or Improves thereon, and who contracts for
such projects with a contractor(s) 8censed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec_ a. & P.G. for this reason
No. 11440
BUILDING: TYPE CONST: OCC: GRP.
A.P. Number
Legal Description
Project Description
Re -Roof — rile
Sq. Ft.
Size
No. No. Dw.
Stories Units
New ❑ Add ❑
Alter ❑ Repair ❑ -Demolition ❑
Estimated Valuation
6,200
PERMIT
AMOUNT
Plan Chk. Dep.
-
Plan Chk. Bal.
Const.
20.00
Mech.
Electrical
Plumbing
S.M.I.
Grading
Date owner Infrastructure
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 fumished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed It' Pennif is for ,e hundred dopers (S 100) valation
or less.)
I certify that in the Perf0of ork for w h,this permit is -issued, I shall not
=any person In aWym.,Tn!sofipcom '" ject to the Workers' Compensation
Laws ofCrnia.Date OwnAxNOTICE TO APPLICANTaak g the C&M16ats of Exemption you should become
subject to the WbikeW compenssrlon provisions of the Labor Code, you must fodhiHN
comply with such provisions or this Pam* ~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.. 3087, 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'l have read this application and state that the above Information is correct
I agree to comp)y 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 -
Malling Address
City; State, Zip
TOTAL I "C 0 0 0 0
REMARKS ,
ZONE: BY-:
Minimum Setback Distances:
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
COLL. AREA
2ND FL. SO. FT.
YARD SPKLR SYSTEM
POR. SO. FT. ®
MOBILEHOMESVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. I SO. FT.
DUCT WORK
DRAINAGE PIPING
WALL SO. FT.
DRINKING FOUNTAIN,
SO FT ®
HEATING (FINAL)
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAVFEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN,
WASHER(AUTOMDISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACEUNIT WALL FLOOR SUSPENDED
GRADING
cu. yd.
= plus xt
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. 0 c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1 % c
SEWAGE DISPOSAL
FIREPLACE
SO.FT.GAR ® iic
HOUSE SEWER
GAS PIPING "
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PLCK.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.
REIN F. STEEL
GAS (FINAL)
TEMP,. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
= plus xt
=_
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING C
v
REMARKS'
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION Q
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESlINITIALS
GARDEN WALL FINAL