13888 (AR)Building 54-811 Ave. Dia
Owner Agri & Janet Gallatin
4
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
Mailing
Address ' P.0. Box 17
City Zip Tel.
E'a Quinta, CA . 92253
Dutch Baker Construction
Address
53-825 Ave. Navarro
clay Quinta, CA Zip 92253 Tel 564-2787
State Lic. City
& Classif. 529362 Lic. # 18$0
Arch., Engr.,
-Designer
Address I Tel.
City I
Zip I
State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7 0) of Division Xof thh}e Business jand Professions Code, and my license is in full force and
SIG TURE `✓" ' o-` - m " 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, alter, improve, demolish, or repair any structure, prior to its issuance also
irequires 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 with Section 7000) of
j Division'3 of the Business and Professions Code, or that. he is exempt therefrom, and the basis
1*_forrthe 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).
e ❑ 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
I-. or improvement is sold within one year of completion, the owner -builder will have the burden
of proving that he did not build or improve for the purpose of sale.)
1' p 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
Ef does not apply to an owner of property who builds or improves thereon, and who contracts for
`I such projects with a contractorts) licensed pursuant to the Contractor's License Law.)
Q.,I am exempt under Sec. B. & P.C. for this reason •sem
1
Date Owner
i 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
O Copy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed i1 the permit is for one hundred dollars ($100) valuation
or less.) i
I certify that in the performance of thg work for which t'is permit is issued, I shall not
employ any person in any manner so as to become subjec to the Workers' Compensation
Laws of California. 1 / . t `
abate Owner "S-� i3l
f{NOVICE TO APPLICANT: If, after making this Certificate 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
1 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
ILDING: TYPE CONST
P. Number
No. 13888
_OCC. GRP.
Legal Description
Project Description
convert to
Enclose
bedroom
rear patio --
AMOUNT
Plan Chk. Dep.
`' }
Plan Chk. Bal.
105.3U
Const..
Sq. Ft. 260
Size
No.'
Stories
No.'Dw.
Units
New ❑ Add ❑
Alter ❑
Repair ❑ Demolition ❑
. 00
S.M.I.
1.41
Grading
Driveway Enc.
Infrastructure
Estimated Valuation
$14,118.00
PERMIT
AMOUNT
Plan Chk. Dep.
`' }
Plan Chk. Bal.
105.3U
Const..
1612.00
Mech.
21. nU
Electrical
24.10
Plumbing
. 00
S.M.I.
1.41
Grading
Driveway Enc.
Infrastructure
TOTALIt
REMARKS
ZONE: BY: x
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop
Side Street Setback from C Line
Side Setback from Proper ' e /�1\
FINAL DATE
INSPE
Issued by:
Date
Validated by:
`' }
Validation:
��v
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SQ. FT. ® $
UNITS
COLL. AREA
SLAB GRADE
YARD SPKLR SYSTEM
2ND FL. SO. FT. @
HEATING (ROUGH)
STORAGE TANK
FORMS I
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
DUCT WORK
ROCKSTORAGE
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
METER LOOP
HEATING (FINAL)
DRAINAGE PIPING
CAR P. I SO. FT.
GAS (FINAL)
WALL SQ. FT.
DRINKING FOUNTAIN
GROUT
URINAL
SQ. FT. ®
FINAL INSP.
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
GRADING
cu. yd.
$ plus x$
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
,VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(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, TEM/PERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SQ. FT. ® c
BATH TUB
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ac
HOUSE SEWER
MESH
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 I/ ' 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 I
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
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
_ $
LUMBER GR.
FINAL INSP.
FRAMING D /,� �A / YI
L [� Z c�10
FINAL INSP.
ROOFING
I�A'Lfttn�
VENTILATION
��c.f! r�tv
(/.L—grJGO
7
REMARKS:
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
August 31, 1995
Gentleman,
Please extend the deadline for our building permit. It was
taken out September 27, 1994. We ran out of money half way
through building our addition. Thank you very much.
Dan and Janet Gallatin
54-811 Ave. Diaz
La Quinta