Loading...
15707 (RR)P.O. BOX 1504 Address 50-007.017.027 Calle ©aXaC_&A OUINTA, CALIFORNIA 92253 Santa Rosa Cove H.D.A. Mailing Address 50107 Calle. Oaxaca City Zip Tel. La Qninta. 92253 Contracto'Bryant Universal ------ 3462 La Campana � City Zip Tel.: Palm Springy 9226fl 320-6022 State Lic. City & Classif.. 365357 1 Lic. # 2233 iarcn., tngr., Designer Address Tel. City (Zip( State I Lic. # h LICENSED CONTRACTOR'S DECLARATION ' eby affirm that I am licensed under provisions of Chapter 9 (commencing with Section of vission'3 of the Business a_n_dd P-�fessionnvs Code, and my license is in full force and 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 the applicant to a civil penalty of not more than rive hundred dollars ($500). ❑ I, 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 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 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 on, owner of property who builds or Improves thereon, and who contracts for such projects with a contractor(s) pcensed pursuant to 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 ceFtgM'copy thereof. (Sec. 3800, Labor Code.) Policy No. ) if -, Company y --� ❑ Copy Is filed with the city. ❑ Certdied 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 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. 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. WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS,UNLAWFUL, AND 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, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. 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. 1 certify that I have read this application and state that the above information is correct." I agree tocomply 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 ateMailing Address City, State, Zip No. 15707 BUILDING: TYPE CONST. OCC: GRP. A.P. Number Legal Description A Project Description- Install new poly urethane foam roof and coating over exsisting built up roo€. Sq. Ft. No. No. Dw. Size Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation ' $12,567.00 PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. Const. .130 .0 nJ Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure TOTAL Q . 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 fromProperty Line'"�� I -Side FINAL DATE INSPECTOR�� Issued by: Date Permit 7 - Validated by: Validated Validation: \\ r t CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBIN33 FEES 1ST FL. SO. FT. ® $ UNITS COLL. AREA SLAB GRADE YARD SPKLR SYSTEM 2ND FL. SO. FT. @ 'HEATING (ROUGH) STORAGE TANK FORMS MOBILEHOME SVC. BAR SINK POR. SO. FT. ® 'DUCT WORK ROCK STORAGE GAR. SO. FT. ® POWER OUTLET ROOF DRAINS METER LOOP HEATING (FINAL) DRAINAGE PIPING CAR P. SO. FT. GAS (FINAL) WALL SO. FT. DRINKING FOUNTAIN. SO. FT. ® URINAL ESTIMATED CONSTRUCTION VALUATION $ cFINAL INSP. WATER PIPING NOTE: Not to be used as property tax valuation FLOOR DRAIN MECHANICAL FEES :GRADING cu. yd. $ plus x$ WATER SOFTENER VENT SYSTEM FAN EVAP.0OOL HOOD SIGN WASHER(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,TEMIPERM LAVATORY HEATING SYSTEM FORCED GRAVITY AMPERES SERV ENT SHOWER BOILER B.T.U. SO. FT. ® c BATH TUB SO. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 1+/a c SEWAGE DISPOSAL SO.FT.GAR ® 3/ac HOUSE SEWER GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEE I I MECH.FEE PL.CK.FEE CONST. FEE ELECT. FEE I SMI FEEPLUMB. FEE T 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 APP.IEOUIP. REINF. STEEL" GAS (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE cFINAL 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 SIGNATURES/INITIALS GARDEN WALL FINAL