15625 (RR)QD�l� �%1 morckv
P.O. BOX 1504 No. 15625
Building 77-127ih47 Via Ruertc. 78-495 CALLE TAMPICO
Address LA QUINTA, CALIFORNIA 92253
Mailing BUILDING: TYPE CONST. OCC. GRP..
Address 50-107
A.P. Number
City Zip Tel.
L.-:iQuinta 92253 Legal Description
Contractor Project Description Re -roof existing built-up 1 t -up•
Bryant Uinivcrz�al .7 wit -h Polyurethane foe and coating.
Address.
3464 La Cama na 'Kav,
City Tel.
Palm Springs Zip
92260
3210,-6022
State Lic. City
& Classif. 365357 LiC.# 2293 Sq. Ft. No. No. Dw.
Size Stories Units
Arch., Engr.,
Designer New 0 Add 0 Alter C3 Repair 0 -Demolition 0
Address Tel.
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I herebLaffirm .ttiat I am licensed under provisions of Chapter 9 (commencing with Section
7 tof, ivis+iah 3 of the Business and'Profess'ons Code, and my license is in full force and
SIGNATURE DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following Estimated Valuation
reason: (Sec. 7031.5.Business and Professions Code: Any city or county which requires a P P 0
permit to construct, after, improve, demolish, or repair any structure, prior to its issuance also
requires the applicant for such permit to Poe a signed statement that he is licensed pursuant to PERMIT AMOUNT
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 Plan Chk. Dep.
subjects the applicant to a civil penalty of not more than five hundred dollars ($500).
0 1,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, Buisness and Const.
Professions Code: The Contractor's License Law' does not apply to an owner of properly who 30-00
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 'reprove 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.I.
such projects with a contractor(s) Pcensed pursuant to the Contractor's License Law.) Grading
0 1 am exempt under Sec. B. & P.C. for this reason
Driveway Enc.
DateOwnerInfrastructure
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. 1 '7 Company _' � ' 1 -
0 Copy is filed with the city. 0 Certi copy is hereby furnished. -
TOTAL 30.00
CERTIFICATE OF EXEMPTION FROM REMARKS
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 become subject to the Workers' Compensation
Laws of California.
Date —Owner
NOTICE TO APPLICANT: ff, 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 of this permit shall be deemed revoked. Minimum Setback Distances:
Front Setback frim Center Line
—Rear Setback from Rear Prop. Line
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND Side Street Setback from Center Line
SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE
HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION,
Side Setback from Property Line
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST. AND — I
ATTORNEY'S FEES.
This is a building permit when properly filled out, signed and validated, and is subject to FINAL DATE INSPECTOR
expiration it work thereunder is suspended for 180 days.
application and state that the above information Is correct. Permit
I I certify that I have read this applir . Issued by:
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 inspe / / . Validated by:
ctibn purposes
-e
Signature of applicantDate _f�/ L-2)
Mailing Address— Validation:
City, State, Zi ------
CONSTRUCTION ESTIMATE
NO.
ELECTRICAL FEES
NO.
PLUMBIN'G FEES
1ST FL. SQ. FT. rg
2ND FL. SQ. FT. Cad
POR. SQ. FT. Cad
GAR. SQ. FT. ®
CAR P. SQ. FT.
WALL SQ. FT.
SO. FT. ®
ESTIMATED CONSTRUCTION VALUATION
$
UNITS
YARD SPKLR SYSTEM
MOBILEHOME SVC.
BAR SINK
POWER OUTLET
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
$
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
'SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
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
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID (& 1 Vi c
SEWAGE DISPOSAL
SQ_FT.GAR ® 3/4c
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 APP.IEQUIP.
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 �I l " 41 f
t.
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION f
CERT. OCC.
FENCE FINAL
INSPECTOR'S SfGNA7URE511NITiALS
GARDEN WALL FINAL