11925 (PLBG)44
P.O. BOX 1504 No. tr� 1-1925
Building 78-105 CALLE ESTADO
Address 37-600 Calle fiemi3 cola LA QUINTA, CALIFORNIA 92253
Owner s '
BUILDING: TYPE CONST. C: OCGRP.
Mailing
Address Sage
A.P. Number
City Zip Tel.
Iia Quif;t; r`: C$ 92253 Legal Description 774-244,012 ;
Contractor' Project Description Sever Hookup
HendticICson Construction, 4nc.
Address,
68-315 Kie'ley Road
City Cathedral�Cfty ziP 92234 Tel. 328-1747
State Lia , , ,` City , t
& Classif. Lic. # 194 Sq. Ft. No. No. Dw.
ArchSize Stories Units
. Engr.,.
Designer y _ New ❑ Add ❑ Alter ❑ Repair ❑ -Demolition ❑
„rc
Address r Tel.
City Zip State
'•= Lic. #
LICENSED CONTRACTOR'S DECLARATION } --
I hereby affirm thai Lam licensed finder provis;ofjsof Chapter 9 (commencing with Secti6n
7000) of Divisio f3 o/fr't��Ie 8usine§s and
�FJr"ofe�s(sions
/Code, and my license is in fu/l11Porce ' d j+
effect. /�Jr4/C ! , t7.0// �i f
SIGNATURES - DATE
OWNER -BUILDER DECLARATION Estimated Valuation
I hereby affirm that I am exempt from the Contractor's License Law for.the following 2,440.00
reason: (Sec. 7031.5,Business and Professions Code: Any city orfcounty which requires a
permit to construct,' after, improve, demolish, or repair any structure, I prior to its issuance also
requires the applicant for such permit to lila 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 q�
.,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 of not more than five hundred dollars ($500).
O I, as owner of the property, or my employees with wages as their sole compensation, will Plan Chk. Bal.
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and Const.
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 of sale.)
❑'l, asownei of the property, am exclusively contracting with licensed contractors to con- Plumbing 30.00
struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law
does not apply to an owner or property who builds or improves thereon, and who contracts for S. M. 1.
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) -
O I am exempt under Sec. B. & P.C. for this reason Grading _
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.)
Pol'cy o. Company
Rip is filed with the city. O Certified copy is hereby furnished.
TOTAL 30_11)0
CERTIFICATE OF EXEMPTION FROM REMARKS
WORKERS' COMPENSATION INSURANCE ! [i
(This section need not be completed if the permit is for one hundred dollars ($100) valuation ;-.xRr}h�=}1,.t7f�%a Ab 55744 j&W -A.}fy.?3, .y,,,. nA io S
or less.)
I certify that in the performance of the work for which this permit is issued, I shall not
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 or Exemption you should become ZONE: BY:
subject to the Workers' Compensation provisions or 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 t
Lender's Address FINAL DATE 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: Date Permit
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. Validated by:
Signature of applicant Date
Mailing Address Validation:
City, State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
SLAB GRADE
r r'
BONDING
YARD SPKLR SYSTEM
2ND FL. SQ. FT.
FORMS
EWER(
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
GAS (ROUGH)
METER LOOP
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
GAS (FINAL) -
TEMP. POLE
DRAINAGE PIPING
CAR P. SQ. FT. ®
GROUT
WATER HEATER
WALL SQ. FT.
FINAL INSP.
DRINKING FOUNTAIN.
BOND BEAM
WATER SYSTEM
URINAL
SQ FT ®
_$
LUMBER GR.
ESTIMATED CONSTRUCTION VALUATION $
FINAL INSP..
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
VENTILATION
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
FIRE ZONE ROOFING
LAUNDRYTRAY
AIR HANDLING UNIT CFM
FIREPLACE
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.
SQ. FT. RESID ® 1Va c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ec
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
EWER(
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
/
y■'
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