RER (10393)77003 Calle Mazatlan
10393
di
Addrress 77-003. Cal? e M
Owner
Dr. Kasper
Mailing
Address
same
City Zip
- La Qu nta . 92253
Contractor
Stark Construction
Address.
' 39725 Garan.. Suite B
Citypaliia Dsrt zip. 92260
State Lic.
Classif... X1,577776
t No.,,
10393
P.O. BOX 1504 e
78-105 CALLE ESTADO-
Sa llai! LA QUINTA, CALIFORNIA 92253 " f
BUILDING: TYPE CONST. -' " OCC: GRP.
A.P. Number
Tel.
Legal Description
Project Description
Replacing window with french doors
Tel.:
345-971.1
City
Lic. # 790
Arch., Engr.; •`
—Designer. - .
Address Tel.
Sq. Ft. No.
Size Stories
New ❑ Add ❑
No..DW.
Units •
Alter ❑ Repair ❑ Demolition ❑
-City Zip State
Lic #
f" t LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
f\7000) of Division 3 of the Business and Professwns Code;,aiid my license isJn full force and. •a
j .fgffect
SIGNATURE - r DATE
OWNER•BUILDERDECLARATION'- >' _' Estimated Valuation
..": -
I hereby affirm that,1am exempt from the Contractors License Law for therfollowing
reason: (Sec. 7031.5,B1Tsiness and Professions Code:. Any, city or county which 'requires a'
permit to construct, alter, improve, demolish, or repair any structure, prior W its issuance also
-requires the applicant for such permit -to rile a signed statement that he is licensed pursuant to - : PERMIT .
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 of Section 7031.5 by 'any applicant •.for, a' permit Plan Chk. Dep. -
. subjects the applicant to a civil penalty of not more than five hundred dollars ($500). -, •• -
❑ 1 as owner of the property or my employees with wages as their sole compensation will - Plan, Chk. Bal.
• 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
employ any person in any manner so as to become subject to the Workers' Compensation
builds or improves thereon and who does such work himself or through • his own; employees,
: -Mech:
provided that such improvements are not dntended.or offered for sale.' If_ however;''the building
or improvement is- sold within one year of completion, the owner -builder will have-thei:burden .
Electrical
of. proving that he did not build or improve for the purpose of sale.)
-
b 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 "
- sub/eat to the Workers' Compensation provisions of the Labor Code, you must forthwith..
comply with such provisions or this permit shall be deemed revoked.
• does not apply to an owner of property -who builds or improves thereon,; and who contracts for
-S:M.I: .
• such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) ,• .. ..
..;
Front Setback from Center Line
Grading
❑ 1 am exempt under Sec. B. & P.C. for this reason
' CONSTRUCTION LENDING AGENCY`
I hereby affirm that there is a construction lending agency -for the performance'of the
Driveway Enc.
Infrastructure
Date owner
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have,a certificate of. consent to self- insure'or'a certificate of
Lender's Name
Worker's Compensation Insurance; ora certified copy thereof: (Sec. 3800, Labor.Code.)••
Policy No. Company
W{[copy is filed with the city. - ❑.Certified copy is hereby furnished.
TOTAL
CERTIFICATE OF EXEMPTION FROM REMARKS
WORKERS' COMPENSATION INSURANCE
(This section need not be completed N the permit is for one.hundred.dollars ($100) valuation
or less.)
1,500
,
itis ora. ^.!
v-'''t,n
450
AMOUNT
r`
45.00
.70.
14
1 NL z
y•
I certify that in the performance of thg 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
', ZONE:
BY: '
- sub/eat 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 Center Line
Rear Setback from Rear Prop. Line
' CONSTRUCTION LENDING AGENCY`
I hereby affirm that there is a construction lending agency -for the performance'of the
Side Street Setback from Center Line
work for which this permit is issued. (Sec. 3097• Civil Code.)
Side Setback from Property Line
Lender's Name
Lender's Address r
This is a building permit when properly filled out, signed and validated; and is subject to
FINAL DATE'
INSPECTOR
expiration it 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-
agree to comply with all city and county ordinances and state laws relating tobuilding
construction, and -hereby authorize representatives -of.. this city to .enter theabove-.-
mentioned property for inspection purposes.
Validated by:
Signature of applicant f Date
Mailing Address—
Validation:
City, State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
2ND FL SQ. FT.
POR. SO. FT. ®
GAR. SO. FT. ®
CAR P. SQ. FT.
WALL SQ. FT. ®
SQ, 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
FLOOR DRAIN
MECHANICAL FEES
HEATING (ROUGH)
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
DUCT WORK
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
HEATING (FINAL)
KITCHEN 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.
SQ. FT. ® c
BATH TUB
BOND BEAM
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 1Yi c
SEWAGE DISPOSAL
LUMBER GR.
SQ.FT.GAR ® 3V4c
HOUSE SEWER
FRAMING 1 G
OL
FINAL INSP.
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
t 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. 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 1 G
OL
FINAL INSP.
ROOFING
N
4
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION -0 ;L :
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL