RR (10810)Building .52-84.5 NAVARRO
Address
Owner
TA4
P.O. BOX 1504 , ►. i N o . 10 810
S1NUDLLY SRFLLYE:
Mailing BUILDING: TYPE CONST. OCC: GRP.;
Address 52$05 NAVA,RRO
City Zip Tel.
LA QUINTA --
Contractor
OWNER BUILDER
Address
ty ._ l
Zlp
State Lic. City
& Classif. - Lic. #
Desig.y.
ner
Address
City Zip State
• Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of the Business and Professions Code, and my license is in full force and
• / _effect.
SIGNATURE DATE
' OWNER -BUILDER DECLARATION '
I hereby affirm that I am exempt from the Contractors License Law for the following
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a
Permit to construct, atter, improve, demolish, or repair any structure, prior to its issuance also
requires the applicant /or such permit to We 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 0l the Business and Prolessans Code, or Mat. he is exempt therefrom, and the basis
for the alleged exemption. Any violatxm of Section 7037.5 Dy 'any applicant for a permit
' subjects the applicant to a civil penalty of not more than five hundred dollars (E500).'
b` I, as owner of the property, or my employees with wages as their sole compensation, will
fJb 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
builds or Improves Hereon and who does such work himself or through his own employees,
provided that'such improvements are not intended or.ofiered for sale. n, however, the budding
or improvement is sold within one year of completion, the owner -budder wig have the burden
of proving that. he did not build or improve for the purpose of sale.) -
O I, as owner of the property, am exclusively contracting with licensed contractors to con,
struct the project. (Sec. 7044, Business and Professions Code: The Contractors License Law
does not apply to an owner of property who builds. or improves Hereon, and who contracts for
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
❑ I am exempt under Sec B. & P.C, for this reason
r
,y Date {-3 t�� OWner._ d.1 (I f�Y!,4 e F
1`
WORKERS' COMPENSATION DECLARATION
I heteby affirm that I have a certificate of consent to self•insuro, or.a certificate of
Worker's Compensation Insurance, ora certified copy thereof: (Sec. 3800,Labor .Code:) -
Policy No. cDmpany • '
❑Copy is filed with.the city. ❑Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM -
.. WORKERS'COMPENSATIONINSURANCE
(This section need not be completed it the pemM is for one hundred dollars ($100) valuation
-
or less.) • ' . r
I certify that in the performance of the work for which this permit is issued, 1 shall not
employ anylperson in any manner so as to. becomefsubject to the Workers' Compensation
Lav�s�dfiCalfoinial i j)�f�l�� �� �;-�r i �j,�;f
'1 .0, i:t'r.� Owner+.. �/.'t�.t`�"".X"._/ )ti.l�li%tai?��
NOTICE
`TO? APPLICANT: B, aRer`maksg fh")s Ceitdreafe of Exemption you s%roukl become
subject to the Workers' Compensation prov'u"is of the Labor Code, you#riwst forthwithcomply with such provkions 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 property 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 sof this. city to enter the above.
mentioned propert
y for inspection purposes.. '
Signature of applicant— Date
Mailing Address
City, State, Zip
A.P. Number
Legal Description
Project Description REROOF
Sq. Ft No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
$850.00 .
• PERMIT AMOUNT
Plan Chk. Dep. ;
Plan Chk. Bal.
Const. $30.00
Mech.
Electrical -
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
Y
TOTAL $30.00
REMARKS
•y«w
�54_''. d'"''PI. is $ t 1111N
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 Propert
y Line
FINAL DATE INSPECTOR
Issued by: Date 'Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
2ND FL. SO. FT.
POR. SQ. FT. ®
GAR. SQ. FT. ®
CAR P. 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 APPJEQUIP.
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.
SO. FT. ® c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/. c
SEWAGE DISPOSAL
SQ.FT.GAR ® rbc
HOUSE SEWER
REMARKS:
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEECONST.
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 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 l % Cla
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION -
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL