10937 (RR)Building
Address 52-905..VILLA
PATRICY FLEMING
P.O. BOX 1504 No. 10937
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA.92253
Addressg 0 BOX 1487
City Zip Tel.
INDIO 1 922.01 134-1-2063
A -a R OFiNG
Address
38060 CHAR,LESWORBH
City Zip Tel.:
CATHEDRAL. CITY 32149265
State Lic. City
&Classif. 61859 Lic.#`�''
Arch., Engr., -
Designer
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
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 . the,
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
the provisions of 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
subjects the applicant to a civil penalty of not more than five hundred dollars.($500). '
.O 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 appty,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. safe.- If, however; the building
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 safe.) I•, . - ' .
❑ I, asowner 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 o rimproves thereon, and who contracts for
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
❑ I.am exempt under Sec.. B. & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
1 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.)
ProllycyjNo. Company '
/
Copy. is filed with the city. 0 Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(rhis section need not be completed ff the permit is for one hundred dollars ($100) valuation
or less.) - -
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, - 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
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.
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'en ter the above-."
mentioned property for inspection purposes. r
Signature of applicant Date
Mailing Address
City, State, Zip
LDING:- TYPE CONST. OCC: GRP.
P. Number
Legal Description
Project Description R.EROOF (ROOK tO ASPHALT)
Sq. Ft. No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation 1800
PERMIT AMOUNT
Plan Chk. Dep.
Plan Chk_ ..Bal.
Const. $30.00
Mech.
Electrical
Plumbing
S.M.I.
Grading r
Driveway Enc.z
Infrastructure
�. tt4.t.f
TOTAL X30.00,
REMARKS
ZONE: BY: t
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
J- FINAL.DATE- INSPECTOR
Issued by: Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
2ND FL. SO. FT.
POR. SO. FT. ®
GAR. S0. FT. ®
CAR P. SD. FT.
WALL SO. FT. ®
SO FT ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN.
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
HEATING (ROUGH)
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
DUCT WORK
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
HEATING (FINAL)
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.
0 SO. FT. ® c
BATH TUB
BOND BEAM
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/. c
SEWAGE DISPOSAL
LUMBER GR.
SO.FT.GAR ® 3/ic
HOUSE SEWER
FRAMING
FINAL INSP.
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)
METER LOOP
HEATING (FINAL)
OTHER APP.IEOUIP.
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 f
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL