10317 (BLCK)Building 54-396 Obregon
Address _
Owner
Bili Haas
Mailing
Address latae
City Zip
LaQuinta 92253
Contractor
Henry Yanez Masonzy
Address
54570 obregan
• ��
vl 4
P.O. BOX 1504N o . 10317
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
564-2221
City Zip Tel.:
La Qufn`as 92253
State Lic. City
& Classif. 381851 Lic. # 38
Arch., Engr.,
Designer
Address Tel.
CityI Zip I State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirmifthat I am licensed under provisions of Chapter 9 (commencing with Section
^x'/000) of Divisioyn 3 of the Business and Professions Code, and my license is in full force and
gect. �f C �" Wt_ A t.1 Vis- r i'i �� t
SIGNATURE A W DATE
OWNER-UILDER DECLARATION
I hereby affirm that I am exempt rom the Contractor's license Lawfor the following
reason: (Sec. 7031.5,Business and Professions Code. Any city or county which requires a
permit to construct, after, improve, demolish, or repair any structure, prior to its Issuance also
requires the applicant for such permit to Ole 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 or 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 rive hundred dollars ($500)..
❑ 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 or 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. 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 lrnprove for the purpose of sale:)
❑ I, as owner of the property, am exclusively contracting with licensed contractors to coir
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. t. 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.).
Polioy No. Company
�O 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 ($100) 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
-
BUILDING: TYPE CO NST.
A.P. Number
Legal Description
Project Description
38' of 31 block
OCC: GRP.
wale.
15' of
6' block
walk.
Sq. Ft.
Size
No.
Stories
No. Dw.
Units
New ❑ Add ❑ Alter ❑
Repair ❑ Demolition ❑
Estimated Valuation
945.00
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal. .
Const.
25.00
Mech.
Electrical
Plumbing
S.M.I.
.10
Grading
Driveway Enc.
Infrastructure
TOTAL
25.10
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. PLUMBING FEES
1ST FL. SQ. FT. ® $
2ND FL. SQ. FT.
POR. SQ. FT. ®
GAR. SO, FT. ®
CAR P. SD. FT.
WALL SO. FT. ®
SO FT ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOMESVC.
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
ROUGH PLUMB.
FLOOR DRAIN
MECHANICAL FEES
HEATING (ROUGH)
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SEWER OR SEPTIC TANK
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
ROCK STORAGE
FOUND. REINF.
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
HEATING (FINAL)
LAUNDRYTRAY
AIR HANDLING UNIT CFM
GAS (FINAL)
TEMP. POLE
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET'
COMPRESSOR HP
POLE, TEMIPERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
WATER SYSTEM
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SQ. FT. ® c
BATH TUB
FINAL INSP.
FRAMI G
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
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/ (/
SQ. FT. RESID ® IVi c
SEWAGE DISPOSAL
VENTILATION
SQ.FT.GAR ® 3/<c
HOUSE SEWER
FIRE ZC NE ROOFING
GAS PIPING
PERMIT FEE
FIREPLACE
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 OR SEPTIC TANK
ROUGH WIRING.
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. ?TEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ -Plus-X$-=$
LUMBER GR.
FINAL INSP.
FRAMI G
FINAL INSP.
ROOFIN G
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/ (/
REMARKS:
VENTILATION
FIRE ZC NE ROOFING
FIREPLACE
SPARK kRRESTOR
GAR. FI REWALL
LATHIN
MESH
INSULA ION/SOUND
FINISH GRADING
FINAL I NISPECTIOW
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARQEI I WALL FINAL