10866 (AR)Building
A Building
51-'813. VALLEJO
. ng
RERNETH SPRINGER
Mailing
Address P 0 BOR 161
City
LA A QUINTA 92253
Contractor
OWNER BUILDER
SAME
TA
P.O. BOX 1504
7&105 CALLE ESTADO t j 0
LA QUINTA, CALIFORNIA 92253
BUILDING- TYPE CONST.
345-3213
p I Tel.:
State Lic. I City
& Classif. Lic. #
-Arch., Engr.; `
Designer -
Address Tel.
City Zip State ) t
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
effect.
SIGNATURE DATE
OWNER•9UILDER DECLARATION
I hereby affirm that.I am exempt from the Contractor's License Law for the following
reason: (Sec. 703 1.5, Businessland Professions Code: Any city or county which requires a
permit 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
the provisions of the Contractor's License Law, Chapter 9 (commencing wfth 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
subjects the applicant to a civil penalty of not more than five hundred dollars.($500). '
I as owner of the property, or my employees with we
as their sole compensation, will
do the work, and the structure is not.intended or offered for sale. (Sec. 7044, Buisness and
ofessions 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,
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
01 proving that he did not build or improve for the purpose of sale.)
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-
struct 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 .
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec. B. & P.C. for this reason
.1'Date� Owner — �''`•%
WORKERS' COMPENSATION.DECLARATION
I hereby affirm that I have a certificate,of'conse6t to self -insure, or a certificate of
Worker's Compensation. Insurance, ora certified copy;tfiereof. (Sec. 3800, Labor -Code.),
Policy No. ' Company w" • ! �'% f •t`
❑Copy is filed with the city. O Certified copy s'hereby furnished: ,
CERTIFICATE OF EXEMPTION FROM;
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 not
employ any person in any manner so as to'become subject to the Workers' Compensation
•
Laws
of�'California
,j Date✓!1•r.. Own't' 14 / ✓
V NOTICE rT0 APPLICANT: If,- after making this Certificat"of Exemption you should become
subject to the' Workers' Compensation provisions oMIL Labor Code, you must forthwith
comply with such provisions or this permit shall be deem revoked.
CONSTRUCTION LENDING AGENCY
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.) -
Lender's Name _--
Lender's Address
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.
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
A.P. Number
Legal Description
No. 10866
OCC: GRP..
Project Description KITCHEN ADDITION REMODEL
Sq. Ft. No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
$7,,4G7.SR
PERMIT AMOUNT
Plan'Chk. Dep.
Plan Chk. Bal. $64.35
Const. , ' 99.00
Mech. 31.30
Electrical 20.08
Plumbing
S.M.I. 1 .80
Grading
Driveway Enc.
Infrastructure
TOTAL 1 *215 •43
REMARKS (i L"aiP,7'_i(L.9141 -"-r 4-9,21
t, "•P l.r 1Yr]43 L }�.pl rtb. �. ::.�.,:; w
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 c Permit
Validated by:
Validation:
' /VT
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
SLAB GRADE
2ND FL. SQ. FT.
BONDING
YARD SPKLR SYSTEM
POR. SQ. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
CARP. SQ. FT. ®
DRAINAGE PIPING
WALL SD. FT.
HEATING (FINAL)
DRINKING FOUNTAIN,
SQ FT ®
GAS (FINAL)
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
SERVICE
FLOOR DRAIN
MECHANICAL FEES
BOND BEAM
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
FINAL INSP. / C
LAUNDRYTRAY
AIR HANDLING UNIT CFM
/� � 2 /G��
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.
SQ. 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 ® V4c
HOUSE SEWER
LATHING
INSULATION/SOUND
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE UPL.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 APPJEQUIP.
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. S`
FRAMING'/ '�Acv
FINAL INSP. / C
ROOFING Sl 1 C�
/� � 2 /G��
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
000
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL