BLDG (9601-065) + PLBG (10791)53220 Avenida Martinez
9601-065
10791
(D LICENSED CONTRACTOR DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with
W Section 7000) of Division 3 of the Business and Professionals Code, and my
^o Q License is in full force and effect.
r- WLicense # Lic. Class Exp. Date
rnZ n Date Signatureof Contractor
coo H OWNER -BUILDER DECLARATION
J W 1 hereby affirm that I am exempt from the Contractor's License Law for the
HCL following reason:
Z ( ) 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, Business & Professionals Code).
( ) I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals Code).
O I a exempt under Section ,lB&P.,C,. for/ttfis re I on
co DSignatureofOw
N
00 rn WORKER'S COMPENSATION DECLARATION
ITd Q I hereby affirm under penalty of perjury one of the following declarations:
Z ( ) I have and will maintain a certificate of consent to self -insure for workers'
U) compensation, as provided for by Section 3700 of the Labor Code, for the
X W LL. performance of the work for which this permit is issued.
O J J ( ) I have and will maintain workers' compensation insurance, as required by
m Q U Section 3700 of the Labor Code, for the performance of the work for which this
C1 U permit is issued. My workers' compensation insurance carrier & policy no. are:
d rn H Carrier Policy No.
Z (This sedon need not be completed if the permit valuation is for $100.00 or less).
w (el certify that in the performance of the work for which this permit is issued,
Cf I shall not employ any person in any manner so as to become subject to the
workers' compensation laws of California, and agree that if I should become
subject to the workers' compensation provisions of Section 3700 of the Labor
Code, I shall forthwith, comply with those provisions.
Date://— i; ` `//Applicant I% A
Warning: Failure to secure Workers' Compensation coverage is unlawful and shall
subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this application agrees to, & shall, indemnify.
& hold harmless the City of Indian Wells, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
1 certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon the
• above-mentioned property for/inspection 1purposes. /
Signature (Owner/Agent)f . f . . +' ! /v' Data v
t.
ALCM
BUILDING PERMIT
PERMITS9601.416.
DATE 1/16/96
VALUATION S310.4)(,J
LOT TRACT
JOB SITE ADDRESS
APN
53-220 MAR INCZ
OWNER
CONTRACTOR
OWNER/RUILDER
j'A E NAVA
53-2:0 AVENIDA MAM INEZ
I.A QjJI9rA CA 92253
C'iil,fl
DESIGNER/ENGINEER
564-7456
USE OFPERMI;.'Af-N1,Rt'k1, WU1i,DING
HeR(30F REPAIR
FEE DESCRIPTION
FEES
RIrROOF 30.00 LS
OSTIMA TED COST CE CONNSTRUCUON
30.00
PIk RIMIT FEE WWWARY
RFIt00 PTF t0t-OW-418-M $30.(")
SUB -TOTAL CONS EWCTiON AND PLAN CHECK
$30.00
+ O LESS PRE -PAID FEES
1
$0.00
! / C L PERMIT FEL"; DUE NOW
S30.00
,1AN 1
B 1996
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
BLOCKWALL APPROVALS
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
If
.. -
4.4
P.O. BOX 1504 N o . 1 U 191
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number, 774- 062--011
Building 53--220 Ave Martinez
Address
Owner
Ms Dee Nava
Mailing
Address same
City Zip Tel.
.La Qninta :2253
L. L. Wilson Cbhs' truotion
Adress
City ' Tel.:
Zip
India 92201 342-2322
State Lic. City
& Classif. 529319 Lic. #
Designer
Address Tel.
City (Zip ( State
Lic. #
r L.ICEi1SED CONTRACTOR'S DECLARATION
1 hereby affirm that 1 am Incensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of the Business and Professions Code, and my license is in full force and
SIGNATURE t " ' " DATE
OWNER -BUILDER DECLARATION
I hereby affrgn that 1 am exempt from the Contractors License Law for the following
reason: (Sec. 7031.5,19usiihess and Prohmsions Code: Any city or county which requires a
Permit to construct, ata, inpmave, derno", or repair any structure, prior to its issuance also
requires the applicant for such permt to tie a -signed statement that he is licensed pursuant *to
the provisions of the Contactors license taw, Chapter 9: (commencing with Section 7000) of
'
Division '3 of the Business and Ptofessiars 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 cht pataty of not more than five hundred dollars.($500).
❑ 1, as owner of the property, or my employees with wages as their sole compensation, will
do the wodr, and the structure is not intended or offered for sale. (Sec.' 7044, Buisness and
Professions Cade: The Contractor's License Law does not apply to an owner of property who
builds or aproves thereon and who does such work himself or through his own employees,
Provided that such improvements are. not Wended or offered for sale. If, however, the building
or improvements said wihn ono year of coi plebon, the .owner -builder will have the burden.
of proving that he cid not bold 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 Professions Code: The. Contractor's License Law
does not appy to an owner d property who builds or unproves thereon, and who contracts for
such projects with a contractor(s) Scensedpursuant to the Contractor's License Law.) -
❑ 1 am exempt under Sem a & P.C. for this reason
Date Owner
YORKERS' COMPENSATION DECLARATION '
I hereby atfirm that 1 have a certificate of consent to self -insure, or a certificate of
Workers 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.
CE711TIFICATE OF EXEMPTION FROM
WORKEW COMPENSATION INSURANCE
(This sermon need not be completed d the pens# is for one hundred dollars ($100) valuation
or less.)
1 certify that in the performance of thF work for which this permit is issued, I shall not
=any ppeerson in any manna so as to become subject to the Workers' Compensation
Laws of Calrt rnia.
Date Owner
Legal Description
Project Description
Sewer Book Up
ZONE:
BY:
subfect to the Mbrkers' Coutpersalim provisions of the - Labor Code, you must forthwith
cbmpywith such prweonsormsPermit shaebedeemed revoked.
'
Minimum Setback Distances:
Sq. Ft.
Size
No. No. Dw.
Stories Units
New ❑ Add ❑
Alter ❑ Repair ❑ - Demolitiori ❑
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY
Side Street Setback from Center Line
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.)
Estimated Valuation
1,-100
PERMIT
AMOUNT
Plan Chk. Dep.
FINAL DATE
Plan Chk. Bal.
This is a building permit when property filled out, signed and validated, and is subject to '
Const
Mech.
Electrical
I certify that I- have read tht application and state that the above information is correct.
Plumbing
30.00
S.M.I.
Grading
construction, and hereby authorize representatives -of this city to enter the above-.
Driveway Enc.
Infrastructure
-
Signature of applicant Date
Mailing Address
Validation:
City, State, Zip
TOTAL I 3[3 =-nii
NOTICE TO APPLK Wf_ IF, after maldhg Ittis Certificate of Exemption you should become
ZONE:
BY:
subfect to the Mbrkers' Coutpersalim provisions of the - Labor Code, you must forthwith
cbmpywith such prweonsormsPermit shaebedeemed revoked.
'
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY
Side Street Setback from Center Line
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.)
Side Setback from Property Line
Lenders Name
Lenders Address
FINAL DATE
INSPECTOR
This is a building permit when property filled out, signed and validated, and is subject to '
expiration if work thereunder is suspended for 180 days.
I certify that I- have read tht 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. PLUMBING FEES
IST FL. SO. FT. ® $
UNITS
COLL. AREA
2ND FL SQ. FT.
YARD SPKLR SYSTEM
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SQ, FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SQ. FT.
DUCT WORK
DRAINAGE PIPING
WALL SO. FT.
DRINKING FOUNTAIN.
SO FT ®
HEATING (FINAL)
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
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
GRADING
cu. yd.
$ plus x$
LAUNDRY TRAY
AIR HANDLING UNIT CFM
FINAL INSP.
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.
SQ. FT. ® c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1+/a c
SEWAGE DISPOSAL
SQ.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 FEEPLUMB. FEE
_j
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. 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
REMARKS:
VENTILATION
FIRE ZONE ROOFING:
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION -
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINI w IALS
GARDEN WALL FINAL