15626 (PAT) • ��
I IIIIIII VIII III VIII IIII 13
_ IE f44QNo. 16626
' � ---- - P.O.BOX 1504
Buildirq 78-495 CALLE TAMPICO
Addrest '49--461 Avila Drive LA QUINTA,CALIFORNIA 92253
Owner
Jerry Horn
Mailing BUILDING: TYPE CONST. OCC:GRP.
Address same as above A.P.Number
.City Zip Tel.
La Q'. iota 922 3 771-3812Legal Description
ContractorProject Description 304 sq. g Cowered Patio
•
Gemettc Construction
Address
P.O. Box 2464
City zip
_ Tel.:
Yucca Valley 92284 323-9445
State Lic. City
&Classif2go103 Lic.# 100i Sq. Ft. 304 No. No.Dw.
Arch., Engr:, Size Stories Units
Designer New ❑ Add ❑ Alter❑ Repair❑ Demolition❑
Address Tel.
City Zip f f State
f i Lic.#
'LICENSED CONTRACTOR'S DE LARAT'IONr/
I hereby affirm that I am licensed under provisions of Ch pfeg9,(commencing with Section
7000)of Division 3ofthe Business and Professions Code,and my license its in full force and
effect. t1' T /!� .•/
SIGNATURE -•r"-r" t- /' .."' DATE -
, ,"OWNER-BUILDER DECLARATION Estimated Valuation
I hereby affirm that`I am exempt from the Contractor's License Law for the following V4,043.00
reason: (Sec. 7031(-5,ays1ness and Professions Code: Any city or county which requires a -
permit to construct rafter, improve, demolish, or repair any structure, prior to its issuance also
requires the applicant for such permit to rile 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 Nat.he Is exempt therefrom, and the basis
for the alleged exemption. Any violation of Section 7031.5 by'any applicant for a permit Plan Chk. Dep. "
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 Plan Chk. Bal. d A in
do the work,and the structure is not Intended or offered for sale.(Sec. 7044,Buisness and Const.
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.)
❑ I,as owner of the property,am exclusively contracting with licensed contractors to torr 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
❑1 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.)
i Poliicy qo. rCompany
V+Copy is filed with the city. O Certified copy is hereby furnished.
TOTAL 2
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.)
1 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., h, 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:
Front Setback from CentevL�e
Rear Setback from RReear prop.Line
WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL,AND Side Street SetbacK f rom Center.Line
SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE
HUNDRED THOUSAND DOLLARS($100,000),IN ADDITION TO THE COST OF COMPENSATION, —Side Setback from PropertyLine�j�
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ' / V
ATTORNEY'S FEES.
This is a building permit when properly filled out,signed and validated,and is subject to FINAL DATE 1 SPECTOR��
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. Issued by: Date Permit-
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. Validated by:
Signature of applicant Date
Mailing Address Validation:
City, State, Zip /
CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBINU FEES
1ST FL. SQ.FT.® $ UNITS
2ND FL. SO.FT.
YARD SPKLR SYSTEM
POR. SQ.FT.® MOBILEHOME SVC. BAR SINK
GAR. SO.FT.® POWER OUTLET ROOF DRAINS
CAR P. I SO.FT.® DRAINAGE PIPING
WALL SO.FT.® DRINKING FOUNTAIN
SQ.FT.® URINAL
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 WASH ER(AUTO)(DISH)
APPLIANCE DRYER GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED LAUNDRY TRAY
AIR HANDLING UNIT CFM KITCHEN SINK
ABSORPTION SYSTEM B.T.U. TEMP USE PERMIT SVC WATER CLOSET'
COMPRESSOR HP POLE,TEMIPERM 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
SO.FT.GAR®3/ac HOUSE SEWER
GAS PIPING
PERMIT FEE 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 APPJEOUIP.
REINF.STEEL GAS(FINAL) TEMP.POLE
GROUT WATER HEATER SERVICE FINAL INSP.
BOND BEAM WATER SYSTEM
GRADING
LUMBER GR. FINAL INSP.
cu.yd.
FRAMING 11111AW
FINAL INSP. $ plus x$ =$
ROOFING
a REMARKS:
VENTILATION
FIRE ZONE ROOFING'
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
IIIIIII VIII III VIII IIII 14
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BUILDING & SAFETY DEPARTMENT
CONDITIONALLY
ACCEPTED FOR CONSTRUCTION
V SUBJECT TO INSTALLATION AS PER
AND ALL APPLICABLE CODES
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