15630 (RR)P.O. BOX 1504 No. 15630
Building t r.° 78-495 CALLE TAMPICO,-'.
Address `78-395. Sandf lowex UINTA, CALIFORNIA 92253
Owner'
Seo Francis of ASSTS
\BUILDING: TYPE CONST. '' - OCC -.GRP
Mailing i
Addressp6o. BOX 15O.V A.P. Number 't
`City Zip Tel.
La Quinta 92353 56:4--1255 Legal Description
Contractor, Project Description "' Odf existing shake root
Bunde Mooting
Address ' '
36399 Cathe al Canyon t
City y, 4 ,qq y Zip (� +] q Tel.'q pt
C`athedrai Cit r 92234 3'2S -1509
State Lic. City
& Classif..$ 1470 Lic. # 3553
Arch., Engr.,:_. f
Designer
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 Professions Code, and my license is in full force and
effect.
0—NATURE 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 rile 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 or not more than rive hundred dollars ($500).
0.1, 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, Suisness 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.) '
O' 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 contractors) licensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec---.' -,—B. WP.C. for this reason
Date C. rAOwner!�' °/� Gj�/,•'
WORKERS' COMPENSATION DECLARATION
I hereby affirm thatliAve6certificate of consent to self -insure, or a certificate of
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800; Labor Code.)
Policy No C
ifith
cot'1 crate `, `tile i
Sq. Ft.
No:
r
No. Dw.
Size
, �:i:Stories
Units
New ❑
Add ❑ .'" 't''Alter ❑
Repair life. Demolition!❑, '
itimated Valuation
W900.00
PERMIT ..'
Plan Chk. Dep. -
Plan Chk. Bal.'
Const.
Mech. '
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
I . 11 • -
r
ompany
❑ Copy is filed with the city, ❑ Certified copy is hereby furnished.
TOTAL t3
CERTIFICATE OF EXEMPTION FROM REMARKS
WORKERS' COMPENSATION INSURANCE
(This section need not be completed !f the permit is for one hundred dollars ($100) valuation
or less.) z:
I certify that In the performance of thg work for which this permit is issued, I shall not ..
employ any parson in any manner,so as to become subject to the Workers' Compensation
Laws of California
Date Owner
NOTICE TO APPLICANT. g; after making -this Certificate of Exemption` you should. become ZONE: `BY:
subject to the Workers' 'Compensation provisions of the labor .Code, you must forthwith Minimum Setback Distances:`
-
comply with such provisions or this permit shall be deemed revoked.
• Front Setback from Center Line•
• fa
Rear Setback from RearoProlne
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND Side Street SetbaClr�Lt`eenter Line
SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE
HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION,
Side Setback fro,PTOpty. Line V�
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND g''\ '
ATTORNEY'S FEES. _ y n, Y/
Ttils'is -a-building pemiit when properly filled out; signed and -validated, and'is subject to
FINAL DATE INSPECTO.Pi2 �-
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 "IX
1 agree to comply with allcity and county ordinances and state •laws, relating to building .- J
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 Val ldati
City, State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBINU FEES
1ST FL. SO. FT. ® $
UNITS
SLAB GRADE
2ND FL. SO. FT.
BONDING
YARD SPKLR SYSTEM
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK +
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SO. FT.
GAS (ROUGH)
DRAINAGE PIPING
WALL SO. FT.
OTHER APPJEOUIP.
DRINKING FOUNTAIN
SO. FT. ®
TEMP. POLE
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GROUT
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SYSTEM
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
FINAL INSP.
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
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 I
IBATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11A c
SEWAGE DISPOSAL
GAR. FIREWALL
SO.FT.GAR ® 3/ac
HOUSE SEWER
LATHING
GAS PIPING
PERMIT FEE
MESH
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
ROCKSTORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
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
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIQNATURESJINITIALS
GARDEN WALL FINAL