9957 (RR)• (74
P.O. BOX 1504 N o.
Building7&105 CALLE ESTADO �
Addres52-795 Mendoza LA QUINTA, CALIFORNIA 92253
Jose Manuel Rodarte
Mailing
Address. 52_795 Mebdiiiza
cityta Quints 1.Zip 92253 Tel -.,
Contractor
Owner/Builder
Address
City
State Lic.
& Classif. .
Arch., Engr.,
Designer '
Address
City
Zip I Tel.:
LDING: TYPE CONST
Number
Legal Description
Project Description Re -roof
OCC: GRP._
s s
•
City
Lic. # Sq. Ft. No. No. Dw.
Size Stories Units
el.
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,'arid my license is in full force and
effect.
SIGNATURE," DATE
OWNER -BUILDER DECLARATION
I;h4 by affirm that I am exempt from the Contractors License Law for the following .
reason: (Sec. 7031.5,Business and Professions Code: Any city or counly.which requires a
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
$700.00
permit to construct, atter. Improve, demolish, or repair any structure, prior to its issuance also
requires the applicant for such permit to lila 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 Section 7031.5 by 'any for
Plan Chk. Dep.
of appiicant a permit
subjects the applicant to a civil penally or not more than five hundred dollars (S500).
Plan Chk. Bal.
❑ 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
Const.
•'U
Professions Code: The Contractor's License Law does not apply to an owner of property who
-
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 Improve 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, 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.1.
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
Grading
❑ I am exempt under Sec. B. & 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 Compensation Insurance, or a certified copy thereof. (Sec. 3800; Labor Code.)
-
Policy No. Company
❑ Copy is filed with the city. ❑ Certified copy is hereby fumished.
_
TOTAL
• ��
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 thg work for which this permit is issued, I shall not
{2"�" 1 )'C
4-'* -77 �
t1`, tad'�i
employ any parson 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
ZONE: BY:
subject to the Workers' Compensation provisions of the Labor Code, you must- forthwith
comply with such provisions or this permit shall be deemed revoked. -
Minimum Setback Distances:
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
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.
Signature of applicant Date
Mailing Address
City, State, Zip
4V
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE INSPECTOR
Issued by: Date 8/26/9Pe1
rmit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
2ND FL. SO. FT.
FOR. SO. FT. ®
GAR. SO. FT. ®
CAR P. I SO. FT.
WALL SO. FT. ®
SO. 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
1KITCHEN 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
I� I L,A� l
SO.FT.GAR ® Vic
HOUSE SEWER
REMARKS:
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PLCK.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. 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
VENTILATION
I� I L,A� l
REMARKS:
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