10601 (RR)tu',K,rcv
P.O. BOX 1504 �� �� . 1060
Buildinge 78-105 CALLE ESTADO
Address 51-286 Velasco LA QUINTA, CALIFORNIA 92253 � 'SOwner
_Chris Sutton
Mailing BUILDING: TYPE CONST. OCC: GRP.
Address
A.P. Number
City Zip Tel.
La Quinta 92253 564-0560 Legal Description
Contractor • Project Description
Nelson Roofing
. Reraof
.Address
523 Wellwood Ave
City Zip Tel..
Beaumont 714/345-2643
State Lic. City
& Classif. C39 516729 Lic. # 1654 Sq. Ft. No. No. Dw.
Size Stories Units
Arch.; Engr.,
Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address Tel.
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I herebrAffirm that I am licensed under provisions of Chapter 9 (commencing with Section
_ ,7000) of Division 3 of the Business and Professions Code, and my license is in full force and
Ne(fect:f
1 NATUR DATE
OWNER-BUILDER DECLARATION Estimated Valuation
hereby affirm that I am exempt from the Contractor's License Law for the following 3,690.00 �
reason: (Sec. 7031.5,Buslness and Professions Code: Any city or county Which requires a 3 a690 • 0 -
permlt to construct, alter, Improve, demolish, or repair any structure, prior to its issuance also
requires the applicant for such permit to file a signed statement that he, is licensed pursuant to PERMIT AMOUNT
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 Plan Chk. Dep. .
subjects the applicant to a civil penalty ofnot more than five hundred dollars.(8500). - Plan Cflk. 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
Professions Code: The Contractor's License, Law does not apply to an owner of property who Const. Wo 00
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. 1t', however, the building Mech..
orImprovement 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 of sale.)
O I, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing
struet 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,I:
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
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 ^. \
O C�py is filed with.the city. ❑ Certified copy is hereby furnished. '
TOTAL 0 0i3
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 thg work for which this permit is issued, I shall not1rt1 All
employ any Person in any manner'so 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 ZONE:. BY: _
subject to the workers' Compensation provisions of the Labor Code, you must forthwith Minimum Setback Distances:
comply with such provisions or this permit shall be deemed revoked.
Front Setback from Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY Side Street Setback from Center Line
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.) Side Setback from Property Line
Lender's Name
Lender's Address FINAL DATE Z'20- `T "L- INSPECTOR
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. Issued by: --1 Date Permit
I *agree to comply with all city and county ordinances and slate laws relating to building I
construction, and hereby authorize representatives -of this city to enter the above-.
mentioned property for Inspection purposes. Validated by:
Signature of applicant Date
Mailing Address Validation:
City, State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
SLAB GRADE
2ND FL. SO. FT.
BONDING
YARD SPKLR SYSTEM
POR. S0. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CARP. 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.000L 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, TEMIPERM
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. Fr. RESID ® 1% c
SEWAGE DISPOSAL
GAR. FIREWALL
SO.FT.GAR ® 3/ic
HOUSE SEWER
LATHING
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO Fj7
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.
/2 /j49
ROOFING /� (
y�
41
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