9990 (MISC)Building
Address 52-0€30 Vallejo
P.O. BOX 1504 N o .
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
Owner
R. L. Pendergraph
Mailing
Address same
City Zip Tel.
La Quinta 92253 564-7497
twiner % $iii lde r
ress
Zip
State Lic. City
& Classif. Lic. #
Arch., Engr.; .
Designer
Address Tel.
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that 1 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 -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Business and Professions Code: 'Any city or county which requires a
permit to construct, atter, improve, demolish, or repair any structure, prior to .its issuance also.•
requires the applicant for such permit to rile a signed statement that he.is-licensed'pursuant to
the provisions of the Contractor's License, Law, Chapter 9 (commencing with Section 7000) of
Division 3 or 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 penally of not more than rive hundred dollars.($500).
TSI 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
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 wig have the burden
of proving that he did not build or improve for the purpose of sale.) . -
❑ .1; 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
asuch projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
O 1 am exempt under Sec."'""`�-. lk b B. & P.0"for this.reason
Ci
' Date r 2 0 owner, I LSj t psi S Ql\ X :.'} < A 4 t'
WORKERS' COMPENSATION DECLARATION
1 hereby affirm that l 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'COMPENSATIONINSURANCE -
(This section need not be completed if the permit ,lsyfor one. hundred dollars ($100) • valuation
or less.)
I certify that in the pe" rfo once of the work for which. this permit is issued, I shall not
employ any person in any manner•so as to becomersubject to the Workers'� Compensation'
Lawts�f Ca Ifbrnia. �
NOTICE TO APPUCANL• Iff aRer makirig.this CeiOttcate of: Exemption you should become
subject to the Workers' Compensation provisions of the Labor Code, you,must forthwith
comply with such provisions or this permit shall be deemed 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 if 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
11LDING: TYPE CONST. OCC: GRP.
P. Number
,Legal Description
Project Description Lot 19 Block 76
New gas line to pool beater & watar__htr
(250,040
BUT used)
Minimum Setback Distances: .
Front. Setback from Center Line
Sq. Ft.
Size •
No.. ,
Stories
No. Dw.
Units
New ❑ Add ❑
Alter ❑
Repair ❑ Demolition ❑
FINAL DATE
INSPECTOR
Issued by:
Date Permit
Validated by:
Validation:
5
Estimated Valuation
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
15.40
S.M.I.
Grading
Driveway Enc.
Infrastructure
AAR trig
5:14. AAP
a.V tr E:.`.ti I IU: EIS„ A ta. VV
TOTAL
15.00
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
N0: PLUMBING FEES
IST FL. SO. FT. ® $
UNITS
SLAB GRADE
2ND FL. SO. FT.
BONDING
YARD SPKLR SYSTEM
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CARP. SO. FT.
GAS (ROUGH) !Q I
111 l
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.COOL 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. FT. RESID ® 1% c
SEWAGE DISPOSAL
GAR. FIREWALL
SO.FT.GAR ® V4c
HOUSE SEWER
LATHING
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) !Q I
111 l
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.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
/�
FINAL INSPECTION -L �`
I�
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL