13333 (RR)1
4
P.O. BOX 1504
Building 78-105 CALLE ESTADO
Address 54-811 Y'7Eii'41DA )IAZ LA QUINTA, CALIFORNIA 92253
Owner
Mailing
Address a E: 11 t.ITZ17,71 DA DIAZ
City Zip Tel.
N.
Contractor
C Sit09 ROOF _NG CO.
Address
City Zip Tel.
3347—:3751.
State Lic. City
& Classif, t._ r 5 2 S r 3 r, Lic. #
Arch., Engr.,
Designer
Address Tel.
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Secfion
7000) of Division 3 of the Business and Professions Code, and my license is in full force and
effect.. i t
GHg7 RE DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractors License Law for the following
reason: (Sec. 7031.5,Uusinoss and Professions Code.- Any city or counly which requires a
permit fo construct, idler, lraplove, demolish, or repair any structure, prior t0 its issuance also
requires the applk•anf for Such permit to fife a signed statoteent that he is licensed pursuant to
the provisions or the Coarraclar's Ldcensa Law, Chapter s (commencing with Section 7000) of
avLsdan 3 of the Business and Professions Cade. 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 io a civil penalty of not more than five hundred dollars (3500).
❑ 1, 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, Bussness and
Professions Code-, The Contractor's License Law does not apply to an owner of property who
builds or hnprovas thereon and who does such work himself or through his own employees,
provided that such improvements are not intended or offered for Yale. 9,, however, the building
or improvement is sold 01ifri one year of completion, the owner-bufder will have the burden
of proving that he did not build or improve for the purpose of sale.)
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-
struct the project. (Sec. 7044, Business and Pfofesslons 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.)
❑ 1 am exempt under Sec. B. & 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
❑ Copy is filed with the city- ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
{rhic section need not be completed if the perm+! is to( orre hundred dollars ($100) valuation
arless.J
I certify that In the performance of thit 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: It. after making this Carfiftaie of Exemption you should become
subject to the Workers' Compensation provfs;nns or the Labor Code you must forthwith
comply with such provisions or this perm)f 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 properly filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days.
I certify that 1 have read this application and state that the above informalion Is correct,
1 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 aboye-
mentloned property for inspection purposes.
Signature of applicant Date
Mailing Address
City, State, Zip
No. 13333
BUILDING: TYPE CONST. OCC. GRP,
A.P. Number
Legal Description
Project Description re—im i'
Sq. Ft. No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated
PERMIT AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS
ZONE:
BY:
Minimum Setback
Distances:
Front Setback from Center Line
Rear 5et?agk Fpov__Rear Prop. Line
Side S feet SetliAck
frM Center Line
Side' ett
Pro ty Line
J I
FINAL DATE
J Ar_D n 1 4g4f?.FEGTOR
Issued by:
Date �' Permit
Validated by.
Validati
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES NO.
PLUMBING FEES
$
UNITS
1ST FL.
SO, FT. ®
_
YARD SPKLR SYSTEM
2ND FL.
SQ. FT.
MOBILEHOME SVC
BAR SINK
POR.
SQ. FT.
POWER OUTLET
ROOF DRAINS
GAR.
SQ. FT. ®
DRAINAGE PIPING
CAR P.
SQ. FT. ®
'-
DRINKING FOUNTAIN
WALL
SQ. FT. ®
i
URINAL
SQ. FT.
ESTIMATED CONSTRUCTION VALUATION
$
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN
EVAP.COOL
HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE
DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL
FLOOR
SUSPENDED
LAUNDRYTRAY
KITCHEN SINK
AIR HANDLING UNIT
CFM
ABSORPTION SYSTEM
B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET'
POLE, TEM/PERM
LAVATORY
COMPRESSOR
HP
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 ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/qc
HOUSE SEWER
GAS PIPING
PERMIT FEEJ
PERMIT FEE
PERMIT FEE
DEL 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
FUHMS
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
LUMBER GR.
FINAL INSP.
cu. yd.
FRAMING
FINAL INSP.
$ plus
x$ =$
REMARKS:
ROOFING
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
n
FINAL INSPECTION
rl
IL�
CERT. OCC.
FENCE FINAL
INSPECTOR'S SfGNATURE&INITIALS
GARDEN WALL FINAL