11695 (RPL)r ,
Building
Address 53-655 Juarez
Owner
Gerhard
Mailing
Address
City Zip
Contractor
Address
4511 E. Sunny Dunes
City ''Zip
Palm Springs, CA 12264
State Lic.
& Classjf. 312674
Arch., Engr.,
Designer
P.O. BOX 1504 N Q . 11695
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
Tel.
structian
Tel.:
32.1'--2030
City
Lic. # 4
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 ofthe Business and Professions Code, and my license is in full force and
effect.
_SIGNATURE •a' !'.i' .,i'Y' / 'E-' i d' 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
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number
Legal Description
Project Description 3 Qool and Sna
Sq. Ft. No.
Size - Stories -
New ❑ Add ❑ Alter ❑
Estimated Valuation $25,000.00
No. Dw.
Units
Repair O
Demolition ❑
- 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
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 five 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
or proving that he did not build or improve for the purpose of sale.) ,
I
PERMIT
-
AMOUNT '
PIan�Chk. Dep.
Plan Chk. BBI.
i3 . �f
'Const.
252 . 40
Mech.
ZQ
Electrical.. " x
45. ('
Plumbing
27 . 00
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 an owner of property .who builds or improves thereon, and who contracts for
• - such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) -
❑ I am exempt under Sec. - B. 8 P.C. for this reason
S.M.I.
2. 50
Grading
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
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Porlic.Y>No. .Company
`O Copy is filed with the city. ❑ Certified copy is hereby furnished.
TOTAL
514.30
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
-
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.
ZONE: BY: -
Minimum Setback Distances:
-
Front Setback from Center I in
CONSTRUCTION LENDING AGENCY
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.)
Lender's Name
Lender's Address
' 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.
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.
Signature of applicant Date
Mailing Address
City, State, Zip
e
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE INSPECTOR
Issued by: Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. ® $
2ND FL. SQ. FT.
POR. SO. FT. ®
GAR. Sq, FT, ®
CAR P. SQ. FT.
WALL SO. FT. ®
Sq FT ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN.
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
STORAGE TANK
FLOOR DRAIN
MECHANICAL FEES
DUCT WORK
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
REINF. STEEL
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
FINAL INSP.
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET'
COMPRESSOR HP
POLE, TEMIPERM
LAVATORY
r
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER. B.T.U.
SO. FT. ® c
BATH TUB
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/. c
SEWAGE DISPOSAL
SQ.FT.GAR ® V4c
HOUSE SEWER
SPARK ARRESTOR
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 kj1VNDERGROUND 3
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) / 93 42 METER LOOP
L
HEATING (FINAL)
OTHER APP.IEQUIP.
REINF. STEEL
GAS (FINAL) TEMP. POLE
GROUT
WATER HEATER SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
FINAL INSP. 1p —10
FINAL INSP. 6j-�Y
GRADING
cu. yd.
$ —plus—x$_=$
LUMBER GR.
FRAMING
ROOFING
`(/� (��7-le
1
REMARKS:
VENTILATION'
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION—Z0-jqLI
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL