9636 (RER)C&tyl
4
P.O. BOX 1504 cqko. 9636
Building 78-105 CALLE ESTADO
Address 48-213 CaI16 Floristas LA QUINTA, CALIFORNIA 92253
Owner
Ron Perkins IBU
.. : - - ILDING: TYPE CONST._OCC,. GRP.�__
Address 'Same
City Zip Tel.
La Ouinta 92253 564-0176
owner."'Builder
Zip
State Lic. City
& Classif. I Lic. #
Arch., Engr.,
Designer
Address
City Zip State
I I Lic. #
LICENSED CONTRACTOR'S DECLARATION
I here -by affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7��'tof Division 3 of the Business and Professions Code, and my license is in full force and
f.c .
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 requires a
permit to constnict, after, improve, demolish, or repair any structure, prior to its issuance also
requires the applicant for such permit to rite 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
suojects the appficant to a civil penalty of not more than five hundred dollars ($500).
VI, 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
build., or bnp ves thereon and who does such work himself or through his own employees.
provided thal'Tuch 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
of proving that he did not build or bnprove for the purpose of sale.)
0 1, 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) licensed pursuant to the Contractor's License Law.)
0 1 am exempt under & 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 Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. -Company *�
0 Copy Is filed with the city. . 0 Certified copy is hereby furnished.
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 thp work for which this permit Is issued, I shall not
employ any person in any manner so as to becomek'subject to the Workers' Compensation
Laws of California.
Date_�_-Ownpr if
Ile, �.�Inq
NOTICE TO APPLICANT i 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 Nam
Lender's Address
This is a building permit when properly filled out, signed and validated, and is subject to
expiration it work thereunder is suspended for 180 days. '
I car tily 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 applicani -Date.
Malli * ng Address
City, State, Zip
A.P. Number
Legal Description
Project Description 161t X 16" ala�,A hInCk Window
Sq. Ft. No. No. Dw.
Size Stories Units
New 0 Add 0 Alter 0 Repair 0 -Demolition 0
Estimated Valuation 100..6150
. PERMIT AMOUNT
Plan Chk. Der
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Driveway Eric.
TOTAL
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
—Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
FINAL DATE
Side Setback from Property Line
INSPECTOR
Issued by; —Date_Permit
Validated by:
Validation:
io
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
I ST FL. SO. FT. @ $
UNITS
SLAB GRADE
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
I
2ND FL SO. FT. @
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING.
MOBILEHOMESVC.
BAR SINK
POR. SO. FT. @
GAS(ROUGH)
METER LOOP
GAR. SO. FT. @
POWER OUTLET
ROOF DRAINS
CAR P. I so. FT. a
TEMP. POLE
DRAINAGE PIPING
WALL SO. Fr. @
i
GROUT
DRINKING FOUNTAIN.
SQ. FT. @
FINAL INSP.
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER SYSTEM
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
FINAL INSP.
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYEA
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
VENTILATION
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. Fr. @ c I
BATH TUB
GAR. FIREWALL
SO. FT. @ c
WATER HEATER
MAX HEATER OUTPUT, B.T.U.
SQ. Fr. RESID @ 1% c
SEWAGE DISPOSAL
SQ.FT.GAR @ V4c
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERM FEE
PERMIT FEE
DBIL
TOTAL FEES
MICRO FEE
MECH.FEE PLCK.FEE
CONST. FEE ELECT.FEE
SMIFEE 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
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
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOWS SIGNATURES[INITIALS
GARDEN WALL FINAL