10391 (PLBG)Building 52-865 OBRBGON
Address
Owner GUILLERMO BERM DEZ
Mailing
Address 1196 CABALLgERO{S� AVE.
WH
Cityau NGS Zlp8s ��4 T7
Contractor
ALMS UNDERGROUND CONSTRUCTION
8703 VISTA DRIVE
4
P.O.,BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
CityZip Tel.:
..
CAEIR r 922AA 324-19
State Lic. City
& Classif. 482150 Lic. # 769
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 Section
7000) of Di Lision.3•of, the Business and Professions Code, and my license is in full force and
`effect. f t� /✓� /' ,��, i
SIGNATURE-- DATE
J OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractoes 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, prior to its issuance also
requires the applicant for such permit to rite a signed statement that hes licensed pursuant to
the provisions of the Contractor's License Law, Chapter 9 (commenting with Section 7000) of
Division 3 of the Business and Professions Code, or Nat. 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 (5500).
❑ 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
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. N however, the building
orimprovement is sold within one year of completion, the owner -budder will have the burden
of proving that he did not build or improve for the purpose of safe.)
❑ I, 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 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
(This section need not be completed if the permit is for one hundred dollars (8100) valuation
or less.)
I certify that in the performance of the 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 of the Labor Code, you must forthwith
comply with such provisions 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 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
No. 14391'
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number
Legal Description
Project Description SEWER HOOKUP
SUPPLEMENTAL- PERMIT FOR PERMIT
010377 (12-11-91). CHANGE OF CONTRACTOR.
Sq. Ft. No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition p
Estimated Valuation $2s500
PERMIT AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL�•-- Q ~""
REMARKS
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 Property Line
FINAL DATE INSPECTOR
Issued by: Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBINC.FEES
1ST FL. ] SO. FT. ® $
UNITS
COLL. AREA
2ND FL. I SO. FT.
ROUGH PLUMB.
YARD SPKLR SYSTEM
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. ] SO. FT. ®
POWER OUTLET
ROOF DRAINS
DUCT WORK
DRAINAGE PIPING
CAR P. SO. FT. ®
GAS (ROUGH)
METER LOOP
WALL ] SO. FT. ®
HEATING (FINAL)
DRINKING FOUNTAIN.
] SO. FT.
GAS (FINAL)
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation'
WATER HEATER
FLOOR DRAIN
j MECHANICAL FEES
FINAL INSP.
WATER SOFTENER
VENT SYSTEM FAN I EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE j DRYER
GRADING
cu. yd.
plus x$
GARBAGE DISPOSAL
FURNACE UNIT • WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT ] CFM
FINAL INSP.
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET'
COMPRESSOR j HP
POLE, TEMIPERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER. B.T.U.
SO. FT. ® c
BATH TUB
j
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1% c
SEWAGE DISPOSAL
SO.FT.GAR ® 314c
HOUSE SEWER
]
GAS PIPING
PERMIT FEE ] '
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
1
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 j
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 I _
REMARKS.
VENTILATION
FIRE ZONE ROOFING:
FIREPLACE 1
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION -
CERT. OCC.
FENCE FINAL
+
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL