04576 (RPL)Building ~ 54-420 RamlxeZ
Address
Jim Z4euhurger
Mailing
Address same
City Zip
La Qu i.nta I 92253
Contractor
Address
78-755 Martinique
Tel.
City Zip Tel.
Barmud� Mata® 3 92201
State Lic. Cit)
& Classif. 476807 Lic. #
Arch., Engr.,
Designer
Address Tel.
P.O. BOX 1504
78-105 CALLE ESTADO
LA OUINTA, CALIFORNIA 92253
BUILDING: TYPE CONST. OCC. GRP.
�. • + A.P. Number 774-244'00
:gal Description
roject Description Pool
• Sq. Ft.
Size
ity (Zip (State
Lic. If
t LICENSED CONTRACTOR'S DECLARATION
I hereby afflrrn`,that I am licensed under provisions of Chapter 9 (commencing with Section
000) of DMdIoo-n,3 of the Business and Professions Code, and my license is in full force and
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractors License Law for the following
reason: .(Sec. 7031.5,Business and Professions Code: Any city or county which requires a
permit to 'construct, alter, 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 the applicant to a civil penalty of not more than five hundred dollars ($500).
O 1, 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, 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 Met 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.)
❑ 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 apply to an owner of property who builds or improves thereon, and who contracts lot
such projects with a contractors) licensed pursuant (p the Contractor's License Law.)
❑ 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 certifiedcopy thereof. (Sec. 3800, Labor Code.)
Policy No. Company r ^�
O 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 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: If, alter 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.
No.
Stories
04576
No. Dw.
Units
New ❑ Add ❑
Alter ❑ Repair ❑ Demolition ❑
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
Estimated Valuation
$7,000
PERMIT
AMOUNT
Plan Chk. Dep.
tql
Plan Chk. Bal.
$40462
Const.
62.50
Mech.
20.00
Electrical
16.00
Plumbing
14..00
S.M.I.
.50
Grading
Validated by:
Driveway Enc.
' Signature of applicant Date
Infrastructure
Mailing Address
Validation:
Cit 'Stat 21
TOTAL
REMARKS
001mll A-0 4AR14_,1.1--hit
A L114,} I a 1140i?iL- Y. aD1� of?,:
ZONE: BY:
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
Lender's Name
Lender's Address
FINAL DATE
INSPECTOR
This is a building permit when properly filled out, signed and validated, and is subject to
tql
expiration it work thereunder is suspended for 180 days.
77
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:
Cit 'Stat 21
Y. e, p
..WHITE FINANCE, PINK -APPLICANT, GREEN BUILDING, GOLDENROD - ASSESSOR'S OFFICE, HARD COPY -FILE ,
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL SO FT ra $
UNITS
SLAB GRADE
ROUGH PLUM /?-;�
BONDING
YARD SPKLR SYSTEM
2ND FL SO FT. 4t
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR SO FT at
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
POWER OUTLET
ROOF DRAINS
GAR SO. FT. Cl
TEMP. POLE
GROUT
DRAINAGE PIPING
CARP. SO FT. 0
FINAL INSP.
BOND BEAM
WATER SYSTEM
DRINKING FOUNTAIN
WALL SO. FT. Q
_$
LUMBER GR.
FINAL INSP.
URINAL
SO. FT.
ROOFING
ESTIMATED CONSTRUCTION VALUATION $
REMARKS:
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)(DISHI
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
SPARK ARRESTOR'
LAUNDRYTRAY
AIR HANDLING UNIT CFM
GAR. FIREWALL
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
FINISH GRADING
SO. FT. @ c
WATER HEATER
MAX. HEATER OUTPUT. B.T.U.
SO. FT. RESID a VA c
SEWAGE DISPOSAL
SO.FT.GAR re VAc
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��ii
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUM /?-;�
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.IEOUIP.
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 ig
/ /4 2 / rn
612
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