10547 (BLCK)t •-.
4 cv,
P.O. BOX 1504 - No. 10547
Building53-945 Eisenhower 78-105 CALLE ESTADO
AddresLA QUINTA, CALIFORNIA 92253
Owner -
mrs. Loone Kerr
Mailing
BUILDING: TYPE CONST. OCC: GRP. -
Address S2u7ie A.P. Number
City Zip Tel.
T,aulinta 92253 Legal Description
Contractor Project Description
Molnar Construction & Dev.
Address 501..E of 3X 4t lit rail fence
77-a027 California Dr.
City Zip Tel.:
P.D. 92260 360-9894
State Lic. City
& Classif. $ 579391 Lic. # 2213 Sq. Ft. No. No. Dw.
Arch., Engr., Size Stories Units
Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address Tel.
City Zlp State
Lic. #
y' LICENSED CONTRACTOR'S DECLARATION
I hereby,afjirm that I am licensed under, provisions of Chapter 9 (commencing with Section
V7000) of Division 3 o/f the /Bdslnesaandd Professions Code, and my license Is in full force and
ffect. � .%fit ys.:f ,/�'�/.°dJ
Is .�T / ' ` - ' - DATE
OWNER -BUILDER DECLARATION Estimated Valuation
I hereby affix that I am exempt from the Contractor's License Law for the following 341.50
reason: (Sec. 7031.5,Bustness 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
requires the applicant for such permit to file a signed statement that he Is licensed pursuant to PERMIT AMOUNT
theprovisionsof 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 lot a permit Plan Chk. Dep.
subjects the applicant to a civil penalty of not more than five hundred dollars ($500). - -
❑ I, as owner of the property, or my employees with wages as their sole compensation, will Plan Chk. Bal.
do the work, and the structure is not Intended or offered for sale. (Sec. 7044, Bulsness and Const. is .00
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.
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.) '
❑ 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 Lew
does not apply to an owner of property who builds or Improves thereon, and who contracts for S.M.I. - .05
such projects with a contractor(s) licensed pursuant to the Contractor's License Lew.)
❑ 1 am exempt under Sec. B. & P.C. for this reason Grading
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
6 -Copy Is filed with the city. O Certified copy is hereby furnished.
TOTAL i5.05
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed If the permit Is for one hundred dollars ($100) valuation
or less.)
I certify that in the performance of thq work for which this permit Is Issued, I shall not
employ any parson 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.
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
REMARKS
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, Peimit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
COLL. AREA
2ND FL. S0. FT.
YARD SPKLR SYSTEM
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. S0, FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. S0. FT. ®
DUCT WORK
DRAINAGE PIPING
WALL S0. 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.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
GRADING
cu. yd.
$ -Plus-x$-=$
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
r
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER. B.T.U.
SO. FT. ® c
BATH TUB
S0. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
FIREPLACE
SO.FT.GAR ® 3/sc
HOUSE SEWER
SPARK ARRESTOR
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 L
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
NSPECTION
FINAL INSPECTION-
CERT.
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL