10412 (RR)UC p
P.O. BOX 1504fN o . 104-12
Building78-105 CALLE ESTADO
Addres551-919. Morales. LA QUINTA, CALIFORNIA 92253--� `.
• Owner
William Wic.zik
Mailing BUILDING: TYPE CONST, A OCC: GRP.
Address 41-740 HC3'pQ1iJel
A.P. Number
City Zip
BerL� qda .Duff- e.s 92 2 Legal Description
Contractor.
Lehman Roof" r Inc � Project Descriptio'm
Address r Re—Roo
3444 W. Harvard _
City Zip Tel.:
Santa Aba 92704 7:
,State Lica City
••&'.Classif. C39 499608 Lic. #
A hE
Sq. Ft. No.
Size Stories
No. Dw.
Units
rc ., ngr.,
-Designer.
New ❑ Add ❑
= Alter ❑ Repair ❑ Demolition ❑;
Address
Tel.
City
Zip
State
_
'
Lic. #
LICENSED CONTRACTOR'S DECLARATION— 1
• I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
.?7000) of Division 3 of th`Business and Professions Code, and my license is in full force and
'
SIGNATURE DATE
OWNER•BUILDERDECLARATION_ r',
-
Estimated Valuation
I hereby affirm'that I am exempt from the Contractor's License Law for the following
7031.5,Business Any
reason:. (Sec. and Professions Code: 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 permifto file a signed statement that he is licensed pursuant to
x 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 7031.5 by 'any for
Plan Chk.. Dep.
of •Section applicant a permit
subjects the,applicant to a civil penalty or not more than five hundred dollars.($500): • • -
-
Plan. Chk. Bal.
,,
O I, as owner of Ahe property, or my employees with wages as their sole compensation, will
- do the work, and the structure is not intended or offered for sale.•(Sec. 7044, Buisness and
„
Const.'_
20
- Professions Code: The Contractor's License Law does not apply to an owner of property who
-
.00
builds or improves thereon and who does such work himself or through his own employees,..
Mech.
-
provided that'such improvements are not intended or offered for sale. If, however, the building. ,
or improvement Is sold within one year. of completion, the owner -builder. will have the burden
Electrical
- -
„ of proving that he did not build or unprove for the purpose of sale.) -
.
' O I, as owner of the: property, am exclusively contracting with licensed contractors to con-
Plumbing
-- -struct the project. (Sec. 7044, - Bust and Professions Code: The Contractor's License Law
.
'does not apply to an owner of property -who builds or improvesthereon, and who contracts for
S.M.I.
such projects with a contractor($) licensed pursuant to the Contractor's License Law.)..
Grading
O I am exempt under Sec. B. 8 P.C. for this reason
_
'
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•Compensatiominsurancei or, a: certified -copy -thereof: (Sec. 3800, Labor Code.)—
- r
' PolicyNo• Company
I. company
is filed with the city. O.Certified copy is hereby furnished.
TOTAL
z0 a0 .
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 lhg work for which this permit is issued, I shall not}c�f"�.
i (}
employ any person in any manner so as to become subject to the Workers' Compensation'
Laws of California.
+,�. L f4J Yt ,� ! a t,f yi s.w v'v
,»
Date ' Owner
,
NOTICE TO APPLICANT: ff, after making this Certificate of Exemption youshould become` '
'subject 'Workers'
,ZONE:
BY:
- .to the Compensation provisions of the Labor Code, you must forthwith
'- comply with such provisions or this permit shall be deemed revoked. - -
Minimum Setback Distances:.
Front. Setback from Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY .
Side Street Setback from Center Line
' Ihereby affirm that there is a construction lending agency for the performance of the
work• for which this permit is issued. (Sec. 3097, civil code.)
Side Setback from Property Line �.
Lender's Name
Lenders Address
'This is a building permit when properly filled out, signed and validated, and is subject to
FINAL DATE
INSPECTOR,
expiration if work thereunder is suspended for 180 days.f
I certify that I have read this application and state that the above information is correct.
ISSUed by:
Date Permit -
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 •
Validated by.!
Signature of applicant Date
f
Mailing"Address
VdlldatlOn:-_
-
_
City, State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL SO. FT. ® $
2ND FL SQ. FT.
POR. SO. FT. ®
GAR. SO. FT. @
CARP. SQ. FT.
WALL SQ. FT. ®
SQ 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
BONDING
FLOOR DRAIN
MECHANICAL FEES
FORMS
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APPJEOUIP.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
TEMP. POLE
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.
SQ. FT. ® c
BATH TUB
SQ. FT. ® c
WATER HEATER
MAX HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11% c
SEWAGE DISPOSAL
///�J�
(/ /�/
SO.FT.GAR ® 3/ac
HOUSE SEWER
VENTILATION
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-STEELGAS
(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
///�J�
(/ /�/
,y"//J�f
z/ -z ( G' / / r/
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION -
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL