12443 (RR)4
P.O. BOX 1504 No. 12443
Building 78-105 CALLE ESTADO
Address 49-1.85 Washington LA QUINTA, CALIFORNIA 92253
Owner Schook 1
BUILDING: TYPE CONST. OCC: GRP.
Mailing
Address Same
A.P. Number
City
Zip
T
f
Remo
La Quinta.. Chi
4
92253
IO.
Legal Description
Contractor
Roklund Roofling
Project Description
Address
34-160 Linda Way
C &.thedral Cit
yzip 92234
Tel 321-04433
State Lic.
City
& Classif. C-39 579664
Lic. # 1724
Sq. Ft.
No. No. Dw.
Size
Stories Units
Arch., Engr.;
Designer
New o Add 0
Alter 0 Repair 0 -Demolition 0
Address
Tel.
City
Zip
State
f
Ji
I A
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed -under ions offChapter 9 (commencing with Section
7000).6f Division 3,of the Busi , , torpyks
P
4effect. fiess and' -,r ions C6de, and my license is in full force and
A -Z_ .A/
SIGNATURE DATE
OWNER -BUILDER DECLARATION
Estimated Valuation
I hereby affirm that I am exempt from the Contractor's License Law for the following
$820.00
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a
permit to construct, after, 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 provisionsof the Contractor's License Law, Chapter 9 (commencing with 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
Plan Chk. Dep.
subjects the applicant to a civil penalty of not more than five hundred dollars ($500).
Plan Chk. Bal.
0 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
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.
ro
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
of proving that he did not build or improve for the purpose of sale.)
0 1, as owner of the property, am exclusively contracting with licensed contractors to con-
Plumbing
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. 1.
such projects with a contractors) licensed pursuant to the Contractor's License Law.)
Grading
0 1 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'sCompensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
PolicA.&_Company
0 Copy is filed with the city. 0 Certified copy is hereby furnished.
TOTAL
3 U Wu-
OF EXEPTION FROM
REMARKS
11CERTIFICATE
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars (5100) valuation
or Iasi.)
,certify that in the performance of thp work for which this permit is issued, I shall not
any person in any manner so as to become subject to the Workers' Compensation
=
California.
DateOwner
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
comply with such provisions or this permit shall be deemed revoked.
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
• CONSTRUCTION LENDING AGENCY
Side Street SefMck from Center Line
Ihereby affirm that there is a construction lending agency fo(the performance of the
work for which this permit is issued. (Sec. 3097, Civil Code.)
I 'A i
Side Setback from Property Line
• Lender's Name
Lender's Address
FINAL DATE
INSPE
This is a building permit when properly filled out, signed and validated, and is subject to
it thereunder is for
expiration work suspended 180 days.
nrl
I certify that I have read this application and state that the above information is correct.
Issued by:
Date
P I
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:
nr%T o ry wn
Signature of applicant Date,
Mailing Address
Validation:
City, State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
COLL. AREA
~ r
2ND FL. S0. FT. @
YARD SPKLR SYSTEM
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO, FT, ®
POWER OUTLET
ROOF DRAINS
CAR P. I SO. FT.
DUCT WORK
DRAINAGE PIPING
WALL SO. FT.
DRINKING FOUNTAIN
SO FT ®
HEATING (FINAL)
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
GRADING
cu. yd.
$ plus x$
LAUNDRYTRAY
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.
SO. FT. ® c
BATH TUB
VENTILATION
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
FIREPLACE
SO.FT.GAR ® 3/ac
HOUSE SEWER
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 !�—/��(�
3 �1Z
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND'
FINISH GRADING
FINAL INSPECTION /,Y _93 L
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL