04411 (RER)Building, 54-7.95 C°a.ile ',Rondo
Address
'Owner . Michael P3schex
Wailin
IAddressl -.2240 Yt=a 'Way
City ZIP32635 ITi
Contractor
4411
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA,92253 ,.
8UILDING:`TYPE CONST. 'OCC. GRP..
A.P: Number
769-076-004
"� ^• •� �
x-
��447--455: . Legal 'Description
Project Description Re -surface outaide of"
Aaaress
-
City
Zip
Tel.
State Lic.
City
' & Classif. ' ',
Lic. # . ,
Sq. Ft.
No. No. Dw: +' ,
Size
Stories Units
Arch., Engr.,
Designer
New ❑ Add ❑
!• Alter ❑ Repair ❑ --'Demolition ❑
Address
Tel.
City
Zip
State
_
Lic. If .
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 Professions Code, and my license is in full force and
effect.
-
• '�
SIGNATURE DATE
' •' OWNER -BUILDER DECLARATION
Thereby 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, 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
Estimated Valuation.
^< <
L
$J00a 00 -
' PERMIT '"
• -
AMOUNTr
Pian Chk. Dep.
- ..
Division 3of 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 (5500).
❑ I, as owner of the properly, or my employees with wages as their sole compensation, will
Plan Chk. Bal.
„ 4
Ct.
!q� ry.',.,.
)y b i,[ V
_ 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
Mech.
t
builds•or improves-ihereon 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
Electrical
-" •' '"
orimprovementiis- 'sold, within, one year of completion, the owner -builder will have the burden
,:Ofproving that he. did not build or improve for the purpose of sale.)
Plumbing F
_
❑ 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 for
S•M,I,
_
.t
such projects with a contractor(s) licensed pursuant tothe Contractor's License Law.) -
O 1 am exempt under Sec. B. & P.C. for this reason -Grading
t .%t::f f • x
+
Driveway Enc.
Date �-y"'��Owner { 3t,E;,a..r_ f,r
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 copy thereof. (Sec. 3800, Labor Code.)
Policy No. Company
O Copy is filed with the city. ❑ Certified copy is hereby furnished.
TOTAL
"
T 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 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.
REMARKS
ry ��,99 rc �t SS� pp�� ee-..
�d0521,02 :til. i N`3d. OU-0i.;G8, 1
+
0 CAN + ? �
Date - ' Owner
NOTICE, -TO APPLICANT: If, after making this Certificate of Exemption youshould 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: _- kr
.Minimum Setback Distances: -
• ".
Front Setback from Center Line
Rear Setback.from Rear Prop. Line
`
'
r 'r, CONSTRUCTION LENDING AGENCY a
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
from Property Line
Lender's Name ..
.Setback
Lender's 'Address ' ^
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.
FINAL DATE "';
INSPECTOR
«>s'
I certify 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 thiscity to enter the above-
mentioned property for inspection purposes.,
Signature of applicant Date 1
Issued by:
Validated by:
Date Permit
'
` Mailing'Address -
"• Validation: -
-
City, -State, Zip
GOLDENROD ASSESSOR'S OFFICE HARD COPY -FILE '
_._-w ti F.. :t_ __..-. A..•i.3.,_.. '1 '[:•`'n-_.. ... �... .. �. ..n_ 0
WHITE FINANCE PINK APPLICANT GREEN - BUILDING,
. ,..«. ,.. _. -.,.-. .-. ._:-:'_ _-rc. ....-..n. .. ,. .. ..]:-,.}._. .:: >! ?','F...�,stii..it�
CONSTRUC71ON ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL SO Fl y $
2ND FL SO FT. gr
POR SO FTa
GAR SO. FT. it
CARP. SO FT. ra
WALL SO. FT. rd
SO. FT. ra
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTEM
BAR SINK
I ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
ROUGH PLUMB
FLOOR DRAIN
MECHANICAL FEES
HEATING (ROUGH)
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH E R(AUTO)(DIS HI
APPLIANCE DRYER
DUCT WORK
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
GAS (ROUGH)
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.
SO. FT. ® c
BATH TUB
BOND BEAM
SO. FT. @ c
WATER HEATER
MAX. HEATER OUTPUT. B.T.U.
SO. FT. RESID a 1'A c
SEWAGE DISPOSAL
LUMBER GR.
SO.FT.GAR Ji c
HOUSE SEWER
FRAMING
FINAL INSP.
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 8 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.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
—/
—77 14—
REMARKS:
VENTILATION
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
((��
LATHING
MESH
INSULATION/SOUND
'
FINISH GRADING
G
` FINAL INSPECTIOWj > "��• O
'
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL