9841 (RPL)ONo. 9841
P.O. BOX 1504
c
Building 53-065 RUB12078-105CALLEESTADO LA Q
Address UINTA, CALIFORNIA 92253 j
JERRY LUGD
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number 774-042-015
Mailing _
Address 79—$60 BOAQERON TRAY
City
Zip
Tel.
BERMUDA DUNES
92201
Legal Description
Description
;
POOL AND SPA
ContractorProject
JERRY LUGO DEV.
Address
SAME
City
Zip
Tel.:
SAME'
State Lic.
City
• & Classif. ,#317390
Lic. # 1973
Sq. Ft.
No. No. Dw.
Size
Stories Units
Arch., Engr.,
Designer
New ❑ Add ❑
Alter ❑ Repair ❑ Demolition ❑
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 Division 3 of the Business and Professlons Code, and my license is in full force and
effect. •,� `r' t r� /--.� y
+'
„
'
SIGNATURE "�.%%/ I— /.� DATE
if OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for, the following
reason: (Sec. 703 fe5,Business and Professions Code: Any city or •county 'Which requires a
permit to constrtuof+ atter° improve, demolish, or repair any structure, prior to its issuance also
requires the applicant for such permit.to file 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 of the Business and Professions Code, or thathe 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 ($500).
O I, as owner of the property, or my employees with wages as their sole compensation, will
Estimated Valuation
-
93480
PERMIT
°
AMOUNT
Plan Chk. Dep.
_
Plan Chk, Bal.
-
Const
3 , 00
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and
Professions Code: The Contractor's License. cense Lew 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. 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 improve for the purpose of sale.)
Mech. '
.
Electrical
Plumbing'
❑ I, as owner of the property, am exclusively contracting with licensed contractorsto con-
stfuct 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
S.M.I.
- - •
Grading
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,c .y thereof° S 0, Labor Code.)
Polizcq'No. Company 1` r int'
t}I Copy is filed with the city. fJ Certified copy is hereby furnished.
f�
TOTAL
S • 4 U
CERTIFICATE OF EXEMPTION FROM
WORKERS'COMPENSATIONINSURANCE
(This section need not be completed if the permit is for one hundred dollars (8100) valuation
or fess.)
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.
REMARKS
1 i1 S�4-taDri t c ;3 a tiL 1 t„!�.
Date_' Owner
NOTICE TO APPLICANT: 9, 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.
ZONE: BY: .. _ ..... .. .
� tiF•v i - C1 .1. 1v .�'�;t. l �y r x s a s � _
Minimum Setback Distance, t) ' 1� , �) hi.s_ ; }�,-; ,, �(�
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
Lender's Name
Lenders 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.
FINAL DATE
INSPECTOR
I certify that I have read this application and state that the above, information is correct
1 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.
Issued by:
Validated by:
Date Permit
Signature of applicant Date
Mailing Address
Validation:
City, State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
COLL. AREA
2ND FL. SQ. FT.
ROUGH PLUMB.
YARD SPKLR SYSTEM
POR. S0. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SQ. FT.
DUCT WORK
DRAINAGE PIPING
WALL S0. FT.
GAS (ROUGH)
DRINKING FOUNTAIN.
SO FT ®
HEATING (FINAL)
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GAS (FINAL)
WATER PIPING
NOTE: Not to be used as property tax valuation'
FLOOR DRAIN
MECHANICAL FEES
WATER HEATER
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
WATER SYSTEM
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
GRADING
cu. yd.
$ plus x$
LAUNDRY TRAY
AIR HANDLING UNIT CFM
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.
SO. FT. ® c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 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 APP./EQUIP.
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
/(✓/
n/%�
"-
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTIONU -1 /
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
'
GARDEN WALL FINAL