10621 (RR)Build!
4 4 QA
P.O. BOX 1504
92 78-234 Hacienda LA QUINTA, CAL FORNIA 92253
Owner
Joan Foster
Address
City
Contrac
Tel.
Ruben M. Vasquez Roofing
'45020 Elm S
A ndi o Zip 92201 Tel.: 347-5683
State Lic: City
&Ciassif. 456495 Lic:# 1157
Arch., Engr.,
Designer
Address I Tel.
City L
- State.
Lic: #
LICENSED CONTRACTORS DECLARATION:.
I hereby affirm that'I am licensed under provislons of Chapter (commencing with Section
7000) of Dlvision3-of the Buelness and PtofessfooaCode, and my Ilcense'Is-in full force and
act. - .. •
'61GNATLRE - DATE
OWNER -BUILDER DECLARATION
I hereby affirm. thata am, exempt from the Contractor's License Law for She following
reason: (Sec.-7031.5,Buslress and Pro/esaians Coda:.. Any city or county which requires a.
Permit to construct, after, improve, demolish, or repair any structure, prior, to its Issuance also
requires Ne applicant for 'such, permit to file a- signedstatementthat he is licensed pursuant to
the provisions of'the Contractors License law, Chapter 9 (commencthl; with Section 7000) of
Division's of the Business and Professions Code, or that..he /s exampt therefrom, and the basis
for the alleged exemption. Any vfaletion of Section 7031.5 by any applicant for a permit -.
subjects the:appf/caM.to a civil penalty o/notmore than five hundred dollars.(T500).
❑ I, as owner,of the property, or riy.employees with wages their sole compensation, will
do the work, and the structure Is not Intended or -,offered for sale. (Sec. 7044, Sulaness and
Professions Code: The Contractor's License law dose 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 oHeied for safe. N however, the building
or Improvement is sold within one year of .completion, The owner-buf(der w111 have the burden
of Oroving tha[he did, not b iild or Improve for the'purposevt see.)
❑ 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
does not apply to an owner of property -who builds or improves thereon; and who contracts for
such projects with a:contractor(s) Ikpnsed pursuant to the Contractor's License Law.). '
❑ 1 am. exempt under Sec. a, & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have- a certificate of consent to self -insure, or a certificate of
Worker's Comperlg�tioq IG9Y ompanycertlfle dopy s eofifSec3�9�800, Labor Code:):
❑ Copy Is filed with
Jh the city., O Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
,(This section need not be completed' N the permit Is for one hundred dollars ($100) vakwtion
or less.) - - ,.
I certify that in the performance of the work ifor which this permit is Issued, I shall,, not
employ any. ppereon In, any manner so, as 4o become"subject':10 the Workers' Compensation
Caws otCalifornia
DateOwner
NOTICE TO APPLICANT: It; after making this Certlt/cate of Exemption you should become
subject to the workers' Compensation provisions of The Labor Code, you must forthwith.
complywith such provisions or this permft ahafibe deemed rev6"d. -
CONSTRUCTION LENDING AGENCY
Ihereby affirm that there is a construction lending agency for the performance of the
work,
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 subjectto
expiration If work thereunder is suspended for 180 days. -
I certify than have read this application and -state that the above Information is correct.
Lagree to complywith aWcity and county ordinances anis 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
McIll.ng-Address
City, state, zip-
- No.
10621
BUILDING: TYPE CONST: OCC: GRP. -
P. Number
Description
Project Description.
Pte -Roof
Sq. Ft. No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation r 300
PERMIT
Plan Chk. Dep.
Plan Chk. Bal.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS
AMOUNT
20.00
ZONE: BY
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
FINAL DATE INSPECTOR
Issued by: Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. ® $
UNITS
SLAB GRADE
2ND FL. So. FT.
BONDING
YARD SPKLR SYSTEM
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT.:@
POWER OUTLET
ROOF DRAINS
FOUND. REINF.
GAS (ROUGH)
DRAINAGE PIPING
CAR P. SO. FT. 0
OTHER APPJEOUIP.
REINF. STEEL
WALL SO. FT.
TEMP. POLE
DRINKING FOUNTAIN.
SO FT ®
GROUT
URINAL
ESTIMATED CONSTRUCTION. VALUATION $
FINAL INSP.
WATER PIPING
NOTE: Not to be used as property tax valuation'
WATER SYSTEM
FLOOR DRAIN
MECHANICAL FEES
o$ -
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.
SO. FT. ® c
BATH TUB
SPARK ARRESTOR
SO. FT. ® e
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
So. FT. RESID M 11/4 c
SEWAGE DISPOSAL.
LATHING
SO.FT.GAR C 3Ac
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMITTEE-
DBL
TOTAL FEES
MICRO FEE
MECH.FEE. PL.CK.FEE
CONST. FEE ELECT: FEE
SMI FEE PLUMB: FEE
STRUCTURE PLUMBING ELECTRICAL HEATING &AIRCOND. 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 xt
o$ -
LUMBER GR.
;FINAL INSP.
FRAMING
FINAL INSP.
ROOFING A
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION21t 7,
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL