11227 (BLCK)r �
f GG+H�GJ
P.O. BOX 1504 No. 11227
Building 78-105 CALLE ESTADO
Address 54-620. RAMIREZ LA QUINTA, CALIFORNIA 92253
Owner
YORK BOURGEOIS
Mailing BUILDING: TYPE CONST. OCC: GRP.
Address p. 0. BOX 477
A.P. Number
CityZip Tel.
PARADISE, CA 35969 Legal Description
ContractorProject Description 350t
X 6' BLOCK WALL
PINSON BROTHERS
Address
45250 SMURR
City Zip Tel.:
IHDIO, C® 1192201 •347-3115
State Lic. City
& Classif. 547897 Lic. # 1469 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,l•am licensed under provisions of Chapter 9 (commencing with Section '
7000) of Division 3'6f the Business,arid Profess /ions Code, and my license is in full force and
A
SIGNATURE i A -'T . • C; i � f V.- L• "i.e DATE
OWNER•BUIL•DER DECLARATION' Estimated Valuation
I hereby affirm that I am exempt from the Contractor's License Law for the following $8 7 5
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a 9 . .
permit to construct, after, improve, demolish, or repair any structure, prior to Its issuance.also "
requires the. applicant for such permit to fife a signed statement that he is licensed pursuant. to PERMIT AMOUNT'
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 plan Chk. De
for the alleged exemption. Any violation of Section 7031.5 by "any applicant for a permit p
subjects the applicant to a civil penalty of not more than five hundred dollars (S500).
O I, as owner of the property, or my employees with wages as their sole compensation, will Plan Chk. Bal.
do the work, and the structure isnot intended or offered for sale. (Sec. 7044; Buisness and COr1St. $108.00
,
Professions Code: The Contractor's License Law does not apply to an. owner or property who
builds or improves thereon and who does such work himself or through his own employees, Mech.
,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 Electrical
of proving that he did not build or improve for the purpose or sale.)
❑ I, as owner of the property, am exclusively contracting with licensed.contractors to corn Plumbing
strut 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 S.M.I. • �.
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
Grading
❑ I am exempt under Sec. B. & P.C. for this reason
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 - ' r, c�s" "+`P_�� .r
Worker's Compensation Insurance, or a certified. copy thereof. (Sec. 3800, Labor Code.) C,'a:'�:4 `1 -•�.li 4 S `.�' E !i Wit' { t `�'" 4 d)v ,' o
IF Bolicy,No. Company tzr-
Copy is filed with the city. 0 Certified copy is hereby furnished.
\` TOTAL 108.90
CERTIFICATE OF EXEMPTION FROM REMARKS
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. N, after making this Certificate or Exemption you should became ZONE: BY:
subject to the Workers' Compensation provisions or 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
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
FINAL DATE
INSPECTOR
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.
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 abovem.
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. ® $
2ND FL. SO. FT.
POR. SO. FT. ®
GAR. SO. FT. ®
CAR P. SO. FT. ®
WALL SD. FT.
SO FT ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPINO'
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
i
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER. B.T.U.
SO. FT. ® c
BATH TUB
BOND BEAM ��4
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
LUMBER GR.
SO.FT.GAR ® 3/ac
HOUSE SEWER
FINAL INSP.
ROOFING
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 APPJEGUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM ��4
TER SYSTEM
FINAL INSP.
GRADING
cu. yd.
$ -plus-x$_=$
LUMBER GR.
FRAMING
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
/
FINAL INSPECTION ` L
vv
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINRIALS
GARDEN WALL FINAL