06899 (ELEC)Building
ArlArccc 799-661 Cortex Mute
Oen Olsson
Address
City
State Lic.I City
& Classif. Lic. #
CityI Zip I State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I am IlcenaeQ Mrrder�lona Codof Chaptdermy9 (u
the Busiries9 and ons e anIG
P.O.. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
OWNEWBUILDER DECLARATION
reason•.. (�Seca7031.5,13usmess and that I am Professions from the Contractor's License Law for the following
Professions Owe: Any � comity ~ requires
permit to construct. ager. Lrmrove. donoBeN, or repair any structure. . prior to ft issua issuance also
requires the apprrcard, for such perms to Me a signed statement that he is 8censed pursuant -to
the Provtsbmo.ol the Contractors License Law, Chapter 9 (commencing with Section 7000) of
Division 3 of the Bushess and:Pro/esalans Code, or that. he is exerrnpt thera/rorrn, and the basis
for the alleged examptiort. Any Wakdmr or Section 7031.5 by 'arty eppOcant for a pemw
sul*wts the spplicard to a chf parially of not more than the hundred dogm (1500).
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, Buisness and
Protesalana Code: The Cwrbadarb License Law does not apply to an owner of properly who
INolds or iriprores thereon and who does such work himself or through his own empioyeea,
provided drat' such impmveme nis. are not intended. or offered for ante. h however, the buNtrg
or knprovement to sold wOhh one year of completion, the owner -budder wig. have Bre burden
of proving that he old not bund or knprove for the purpose of safe.)
❑ 1, as owner of the property, am exclusively contracting with licensed contractors to con-
struct the project. (Sec. 7044, Business and Professions Code: The Contractors License Law
does not apply to an ower of property who builds or ingnoves thereon, and who contracts for
such prc0cmwith a eantmetor(s) acensed pursuant to the Contractors License Lew.)
❑ 1 am exempt under Sec. B. & P.C. for this
Date Owner
WORKERS COMPENSATION DECLARATION
herebyaffirm 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 Na company
ElCopy is filed with the city. r7 Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS COMPENSATION INSURANCE
(This section need not be coned if the Penh Is for one hundred dusts (S100) valuation
or Mee.)
1 certify that in the performance of the work for which this permit is issued. I shall not
employ any' n in any manner so as to became subject to the Workers• Compensation
Lava of California
Date________Aw,ner -
NOTICE TO APPLICANT: lr, after nuftV fila Certificate of Exemption you should become
suhilect to the Nbdmm* Corwernsadon provisions of the Labor Code, you must forthwith
comply with -sunt provkJons or this pemM shad be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there: is a.eonstructton lending, agency for the performance of the
work for which this permitis issued. (Sec. 3087; Civil Code.)
Lenders Name
Lenders Address
This Is a building permit when propertyfilled out, signed and vaitdated and is subject to
expiration It work thereunder is suspended for 180 days.
I certify Drat 1 have read this appllcatlon end state that the. above Information is correct
e�tru
mE dion, PIy with all city and county otdinanoae and stats laws relatlng to building
rend hrateby authorize repreaentattves of this city to enter tine
-above-.
ntioned prgperly far inspection purposes
Signature of applicant Date
Malting Address
City,, State, Zip
No. 06899
TYPE CONST. OCC: GRP.
Number 617-113-015
Description
Project Description F-Ul ace ---etpr enn
REMARKS
ZONE: BY:
Minimum Setback Distances:
Front Setback from.Center Line
Rear Setback from Rear Prop. Line
SideStreet Setback from Center Line
Side Setback from Property Line
FINAL DATE INSPECTOR
1/24/93
Issued by;. Date Permit
Validated by:
Validation:
Sq. Ft.
Size
No.
Stories
No. Dw.
Units
New ❑ Add O
Alter 0
Repair ❑ -Demolition O
Estimated Valuation
$500
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const..
25.00
Mech.
Electrical
Plumbing
S.M.I.
.07
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS
ZONE: BY:
Minimum Setback Distances:
Front Setback from.Center Line
Rear Setback from Rear Prop. Line
SideStreet Setback from Center Line
Side Setback from Property Line
FINAL DATE INSPECTOR
1/24/93
Issued by;. Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SQ. FT. 0 $
UNITS
SLAB GRADE
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL SQ_ FT. 0
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING.
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
GAS (ROUGH)
METER LOOP
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
GAS (FINAL)
TEMP. POLE
DRAINAGE PIPING
CAR P. SQ. FT. 0
GROUT
WATER HEATER
WALL SQ. FT.
FINAL INSP.
DRINKING FOUNTAIN.
BOND BEAM
-
WATER SYSTEM
URINAL
SO FT ®
=$
LUMBER GR.
ESTIMATED CONSTRUCTION VALUATION $
FINAL INSP.
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
VENTILATION
GARBAGEDISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
FIRE ZONE ROOFING
LAUNDRYTRAY
AIR HANDLING UNIT CFM
FIREPLACE
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.
SQ. FT. ® c
BATH TUB
SQ. FT. @ c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1% c
SEWAGE DISPOSAL
SQ.FT.GAR @ 3Ac
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH:FEE PLCK.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 APPJEQUIP.
REIN F. 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
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURE811NITIALS
GARDEN WALL FINAL