13164 (RPL)44 0 1
P.O. BOX 1504 No. 1316:4
Building 78-105 CALLE ESTADO
Address 51-315 Ramirez LA QUINTA, CALIFORNIA 92253
Barcon Development Corp.
Mailing
Address 41625 Eclectic #H-1
City Zip Tel.
Palm Desert, 92260 773-9024
Contractor
Same
Address
.City I Zip , Tel.
State Lic. B 564202 City 1219
& Classif. Lic. #
Arch., Engr.,
Designer
Address I Tel.
City Zip State
I I Lic. #
LICENSED CONTRACTOR'S DECLARATION
,rl hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
J7000) of Division 3 of the Business and Professions Code, and my license is in full force and
7.<fect.
SIGNATURE DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for 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 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 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 thejapplicant to a civilpenalty ofnot more than five hundred dollars ($500).
0 1, as owner of tlhe`tirop'�rty, 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 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.)
0 1, 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 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.)
0 1 am exempt under Sec. -B. & 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.)
Policy No. Company
0 Copy is filed with the city. 0 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 thp 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 Addres
This is a building permit when properly filled out, signed and validated, and is subject to
expiration it work thereunder is suspended for 180 days.
I car tify 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 Addres
City, State, Zip
BUILDING: TYPE CONST
A.P. Number
Legal Description
P . roject Description Pool
OCC. GRP.
Sq. Ft. No. No. Dw.
Size Stories Units
New 0 Add 0 Alter 0 Repair 0 Demolition 0
-
—BY:
a
w As AL JD JUL 12
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Estimated Valuation $9,400.00
PERMIT
AMOUNT
Plan Chk Dep.
—INSPECTOR
Plan Chk. Bal.
76.05
Const.
117.00
Mech.
24.00
Electrical
45.00
Plumbing
27.00
S.M.I.
1.00
Grading
Driveway Enc.
Infrastructure
TOTAL
290.05
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. PLUM BI Nj*IFEES'-�,.
I ST FL. SO. FT. @ $
UNITS
UNDERGROUND
r
COLL. AREA
YARD SPKLR SYSTEM
2ND FL. SO. FT. @
BONDING
HEATING (ROUGH)
STORAGETANK
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. @
DUCT WORK
ROCKSTORAGE
FOUND. REINF.
POWER OUTLET
ROOF DRAINS
GAR. SO. FT. @
OTHER APPJEQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
DRAINAGE PIPING
CAR P. SO. FT. @
GROUT
WATER HEATER
WALL SQ. FT. @
FINAL INSP.
DRINKING FOUNTAIN
BOND BEAM
WATER SYSTEM
URINAL
SO. FT.- @
LUMBER GR.
ESTIMATED CONSTRUCTION VALUATION
FINAL INSP.
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 DRYEFi
A
INV V 11
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
1JAf
I Vf- L
LAUNDRY TRAY
AIR HANDLING UNIT CFM
I
IKITCHEN 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
GARDEN WALL FINAL
SO. FT. @ c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID @ 11/4 c
SEWAGE DISPOSAL
SO.FT.GAR @ 3/4c
HOUSE SEWER I
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE ELECT.FEE
SMIFEE 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)
STORAGETANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCKSTORAGE
FOUND. REINF.
GAS (ROUGH) cr,
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
S-
REMARKS:
Al
VENTILATION
It," 2A
FIRE ZONE ROOFING
A
INV V 11
FIREPLACE
SPARK ARRESTOR
1JAf
I Vf- L
GAR. FIREWALL
LATHING
4
A
MESH
INSULATION/SOUND
FINISH GRADING
J
FINAL INSPECTION
V A
d/ly -a
CERT. OCC.
FENCE FINAL
11
k -A r
INSPECTOR'S SIGNATURES11NITIALS
V
10
GARDEN WALL FINAL
V