003028 (BLCK)4
4
P.O. BOX 1504 NQ, 003028
Building 76-5.55 Ult� LA QUINTA, CALIFORNIA92253
Address '
Rick Johnson Constmetim
Mailing
Address P. 0 Mow
City Zip Tel.
t 1^ x '+4f»m .92260 564—.2228
Contractor
Address
ITel. "
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number. 9I�il.—iRtS
Legal Description
Project Description Rlfweu -War1I
State Lic.City
& Classif. 397-169
Lic. # 202
Sq. Ft.
No. No. Dw.
a
Size • - 250.
• Stories Units
Arch:, Engr.; . _
Designer
New ❑ Add ❑g Alter ❑ Repair ❑ •. Demolition ❑
Address
Tel.
City
Zip
State
.
Lic. #
. - LICENSED CONTRACTOR'S DECLARATION
I hereby affirm 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
y effect. �,;� ,�w,�,;rfr :,,� ;
�S1SaNATl1RE DATE
- -,
OWNER -BUILDER DECLARATION
Estimated VBIUatlOrl
Estimated
I hereby affirm that I am exempt from the Contractor's License Law for the following
'
. reason: (Sec. 7031.S,Buslness and Professions Coder Any city or' county which requlres a
permlt to construct, alter, Improve, demolish, or repair any structure, prior to Its Issuance also
requires the applicant for such permit to Mlle a signed statement that he Is licensed pursuant to -
PERMIT -d,
• - AMOUNT -
the provisions of the Contractor's License Law, Chapter. 9 (commencing with Section 7000) ofa
- . .
"'Division 3 of the Business and Professions Code, or that. he Is, exempt therefrom, and the basis
for the Any Section by 'any for
r
Plan Chk: Dep.
- ..
'
alleged exemption. violation of .7031.5 applicant a permit
subjects the applicant to a civil penalty of not more than five hundred dollars (8500).
Plan' Chk. Bal.
$40.62
0 I, as owner of the property, or my employees wlth wages as their sole compensation, will -
do the work, and the structure Is not Intended or offered for sale. (Sec. 7044, Bulsness and "
COr1St.
(�;�, �
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. -
•
provlded_that such Improvements are not -Intended or offered for sale. If, howgver,, the building
-
or Improvement Is sold within one year of completion, the owner•bullder will 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 exclusivelycontracting with licensed contractors to con-
Plumbing
struct the project. (Sec., -7044; Business and Professions Code: The Contractor's License Lew
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
❑ I am exempt under Sec. B. t. 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
❑ Copy,is,filed with the city. ❑ Certified copy Is hereby furnished. '
TOTAL
$ln3.62
CERTIFICATE OF EXEMPTION FROM
REMARKS
WORKERS' COMPENSATION INSURANCE
(This section need not be completed If the penult Is for one hundred dollars (8100) valuation
-
or -less.) - -
;• I certify that In the performance of the work for which this permit Is issued, I shall not
• •• employ any pparson In any manner so as to become subject to the Workers' Compensation
Laws of Callfornia.
Date Owner
NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become
ZONE:
BY:
subject to the Workers' Compensation provisions *of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
Minimum Setback Distances: '
Front Setback from Center.Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY
Side Street Setback from Center Line
I hereby affirm that there Is a construction lending agency for the performance of the
whic
work for h this permit Is Issued. (Sec. 3097, Civil code.)
Side Setback from Property tine
Lender's Name
Lender's Address
This is a building permit when properly filled out, signed and validated, and is subject to '
FINAL DATE
INSPECTOR
INSPECTOR -
expiration It work thereunder Is suspended for 180 days. �-%��•$�
I cartify.that I have this
read application and state that the above Information is correct.
I
Issued by:
Date permit
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 -
men tloned property for Inspection purposes.
Validated, by:
Signature of applicant Date
Mailing Address
Validation:
City, State, Zip
_,.
A..76.b.9..
4 3 _..3,62 R
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. ® $
2ND FL. SQ. FT.
POR. SO. FT. ®
GAR. SQ, FT. ®
CAR P. SQ. FT.
WALL SO. FT.
SO FT ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
BONDING
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
SEWER OR SEPTIC TANK
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
DUCT WORK
LAUNDRYTRAY
AIR HANDLING UNIT CFM
FOUND. REINF.
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
GROUT
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c `
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ec
HOUSE SEWER
GRADING
cu. yd.
$ plus x$
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 APP.IEQUIP.
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.
1 FRAMING :� a
FINAL INSP.
ROOFING
�--
DEC
9 `g� lie
J +
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
i GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESANITIALS
GARDEN WALL FINAL