PLBG (12253)�4•
1 �
Building
Address ..2--11.1 Navarro
Owner k'
IIs,. Sherrie Hill
Mailing "
Address �a�41c
Cityt Zip
La Q"#i a,•.. Ch 9% 253
Contractor'—. -i
Hendr-tickd s . Constructs
12253, A
P.O. BOX 1504 N o . 122'5 3 ,; .
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
BUILDING: TYRE CONST. OCC: GRP.
A.P. Number'
Tel. s.
Legal Description
Project Description Sewer Connect
I, TIBC.
W0 -4.L_; x>, aoc i. g %vwas
_ , .1
City=
Cathedral City
Zip 94-234
Tel.:
328-1747
State Llc
& Class`rfi'`2 5618
City
�4 Lic. #
Sq. Ft. `a
Size
No. No. Dw. r `
Stories Units f �•
-- Arch.'Engr.,
Designer;;"„ :' - '
New ❑ 4 Add ❑
Alter ❑ Repair ❑ :Demolition O
Addresslt ��; r
Tel. >
h
City a '
Zip
State
Lic. #
t LICENSED CONTRACTOR'S DECLARATION
I hereby affirm.that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of DivisionSof1hp Business and Professions Code, and my license is in full force and
effect r�
SIGNATI,REV DATE
=' 1`'r' •' - 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 construct, alter, Improve, demolish, or repair any structure, i prior to its issuance also
requires the applicant for such permit to file 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
' subjects the applicant to a civil penalty of not more than five hundred dollars ($500).
O I, 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
Estimated Valuation
- -
,
$1,638.00
- '• '
PERMIT -
-
-AMOUNT
Plan Chk. Dep.
-
-
Plan Chk. Bal.
Const .
builds or improves thereon and who does such work himself or through his own employees,
'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
of proving that he did not. build or improve for the purpose of sale.)
Mech.
-
Electrical
_
Plumbing
❑•l, 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 contractors) licensed pursuant to the Contractor's License Law.)
❑ I am exempt under Sec.'• B. 8 P.C. for this reason
-S.M. 1.
Grading
Driveway Enc.
• '
,Date Owner
Infrastructure
'A 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.)
r,
'
Policy No. Company
❑ Copy'is filed with the city. 0 Certified copy is hereby furnished.
TOTAL
-
CERTIFICATE OF EXEMPTION FROM
t. WORKERS' COMPENSATION INSURANCE
REMARKS
`
(This section need' not be completed if the permit is for one hundred dollars ($100) valuation
orless.).i,'
I certify that in the performance of thg 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: If, after making this Certificate of Exemption you should become
subject to the Workers' Compensation provisions or the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
ZONE: BY: -
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback4rom Rear Prop. Line
CONSTRUCTION LENDING AGENCY
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.) -
Lender's Name
FINAL DATE
Side Street Setback from Center Line
Side Setback from Property Line
%
INSPEC np
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.
Issued by:
Validated by:
Date Per r
1
Signature of applicant Date
Mailing Address`
Validation:
/ e
El �ruw , .
City, State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
SLAB GRADE
2ND FL. SQ. FT.
BONDING
YARD SPKLR SYSTEM
STORAGE TANK
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
DUCT WORK
ROCK STORAGE
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
HEATING (FINAL)
OTHER APP.IEQUIP.
DRAINAGE PIPING
CAR P. I SQ. FT.
TEMP. POLE
WALL SQ. FT.
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
WASHER(AUTO)(DISH)
APPLIANCE DRYER
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.
SQ. FT. ® c
BATH TUB
GAR. FIREWALL
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ac
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 t3R'S�Pfi9iAMIFo
2 ROUGH WIRING
J
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
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 5NAL