13594 (AR)P.O. BOX 1504 N o . 13594
Building 54-1:60 AVe. Vallejo 78-105 CALLE ESTADO
Address LA QUINTA, CALIFORNIA 92253
Owner John & Claw Kohler
Mailing BUILDING: TYPE CONST. OCC: GRP.
Address Satae. A.P. Number
City Zip Tel.
La Quintal CA (2253 564--0869 Legal Description
ContractorRoom Addition
Rossi Construction Project Description
Add,
egbo Madison -914
CityZip Tela
IndictorCA92201
State Lic. City
& Classif. 622093 Lic. # Sq. Ft. 180.5 No. - No. Dw.
.. _
Size - Stories Units
Arch., Engr.,
Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition 7
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
effect.
_SIGNATURE DATE _
OWNER -BUILDER DECLARATION Estimated Valuation $9,440.00
�a a! A
I hereby affirm that I am exempt from the Contractor's License Law for the following $�c s f 4 40 t Del
reason: (Sec. 7031.5,13usiness and 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 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 thathe 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 of not more than five hundred dollars ($500). Plan Chk. BBI. • • / y yt� �/
O 1, as owner of the property, or my employees with wages as their sole compensation, will 117.00
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and Const. 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.], �.��
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
�,,.pQ
of proving that he did not build or improve for the purpose of sale.)
O 1, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing *00
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 .S.M.I. 094
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 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.)
Policy No. ' Company
❑ .Copy is filed with the city. ❑ Certified copy is hereby furnished. ry
TOTAL
CERTIFICATE OF EXEMPTION FROM REMARKS
WORKERS' COMPENSATION INSURANCE In ��
(This section need not be completed if the permit is for one hundred dollars ($100) valuation
or less.) I II ' -
I certify that in the performance of thg work for which this permit is issued, I shall notv
,
employ any person in any manner so as to become subject to the Workers' Compensation ; I II
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. °
Pi
Front Setback from Center. -inr
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY t 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
This is a building permit when properly filled out, signed and validated, and is subject to FINAL DATE INSPECTOR
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. 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
r
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. w PLUMBING FEES
A.C. UNIT
COLL. AREA
SLAB GRADE
1ST FL. SQ. FT. ® $
UNITS
HEATING (ROUGH)
STORAGE TANK
FORMS
YARD SPKLR SYSTEM
2ND FL. SO. FT.
DUCT WORK
ROCKSTORAGE
FOUND. REINF.
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
OTHER APPJEQUIP.
REINF. STEEL
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
*Stf1 R
DRAINAGE PIPING
CARP. - SO. FT.
FINAL INSP.
WALL SQ. FT.
WATER SYSTEM
DRINKING FOUNTAIN.
GRADING
cu. yd.
$ plus x$
=$
URINAL
SQ FT ®
FINAL INSP.
FRAMING,6 G
ESTIMATED CONSTRUCTION VALUATION $
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
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
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.
SQ. FT. ® c
BATH 'TUB
SQ. FT. ®c fWATER
HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ac
HOUSE SEWER
FINAL INSPECTION 6 G r
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
ROCKSTORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
*Stf1 R
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
FINAL INSP.
FRAMING,6 G
FINAL INSP.
ROOFING / `/.Ll� �
�j� � /� 9� � �
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL (d y'7—c) l
LATHING
!O T
MESH
INSULATIONISOUND !�
FINISH GRADING
FINAL INSPECTION 6 G r
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL