10884 (RPL)e
....
P.O. BOX 1504 No. 10884
Building 78--845 La Palma Dr. 78-105 CALLE ESTADO
Address LA QUINTA, CALIFORNIA 92253
rt lour ley
Address Se1.T`tle
City 4 Zip Tel.
La Quinta 92253,
Contractor
Steve Addison Construction
Address ..
68805 A Perez Rd #E9
City- Tel.:
Cat City Zip 92234 324-1232
State Lic. City
&Classif. A 574127 Lic.# 1044
Arch., Engr.,
Designer
BUILDING: TYPE CONST. OCC:.GRP.
Number
Legal Description
Project Description
Poa.1 and Spa
Sq. Ft. No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑
Demolition ❑
Address
Tel.
City
Zip
State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
1 hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 Whe Business and Professions Code, and my license is in full force and
effect. YI i
�`1GNATUDATE
.
' r OWNER -BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractor's License Law for the following
Estimated Valuation 15-t 800
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 applkant for such permit to rile 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 theBusinessand 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
Plan Chk. Dep. -
subjects the applicant to a civilpenalty of not more than five hundred dollars.($500).
Plan Chk. Bal.
1 11.15
O 1, 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
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,
that
Mech.
.
27.00
provided such improvements are not intended or offered for sale. If, however, the building.
or improvement is sold within one .year or completion, the owner -builder will have the burden
Electrical
45.00
.. _, of 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-
Plumbing
a Q
- 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..1.
5p
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
Grading
.
• ❑ I am exempt under Sec. B. & 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 116411
} , n
6 Copy is filed with the city. ❑ Certified copy is hereby furnished. ! �f)'f e
TOTAL 379.75
CERTIFICATE OF EXEMPTION FROM
WORKERS'. COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars (8100) valuation'
orless.)
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, alter making this Certificate of Exemption you should become
subject to the Workers' Compensation provisions of the Labor * Code, you must forth. ith
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.perfo' ante of the
work for which this permit is issued. (Sec. 3097, Civil Code.) \N 1
Lenders Name
Lenders 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.
1 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
REMARKS
ZONE: BY:
Mi I T Setback Distances:
Front Srrtbac-R, rom Center Line
He`arSetback4rom Rear Prop. Line
SiA Street Setback from Center Line
1 Side�ck-from Property Line
FINAL DATE_ AINSPECTOR
Issued by: Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO: ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. ® $
2ND FL SO. FT.
POR. SO, FT, ®
GAR. SO. FT. ®
CAR P. SO. FT.
WALL SO. FT. ®
SO, FT ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTE91
BAR SINK
ROOF DRAINS,
DRAINAGE PIPING
DRINKING FOUNTAIN.
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
BONDING
FLOOR DRAIN
MECHANICAL FEES
FORMS
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APPJEOUIP.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
TEMP. POLE
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET'.
COMPRESSOR HP
POLE,TEMIPERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
JAMPERES SERV ENT
SHOWER
BOILER. B.T.U.
SO. FT. ® c
BATH TUB
SO. FT. ®c
IWATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
D
SO.FT.GAR ® V/ac
HOUSE SEWER
VENTILATION
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 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
D
/
�(
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION -
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL