15023 (BLCK)414Qt��1GV
P.O. BOX 1504
Building., 78-495 CALLE TAMPICO
52
Address 52-501 Ave. Velasco LA QUINTA, CALIFORNIA 92253
Owner James Belknap G
maning P.ri. box Zy 7
Address
Cityip Tel.
.lPalm,.Desert, CK_ . 92261 564-2783
Contractor
Sel)map Construction ' .
Address
State Lic.
& Classif.. B-652815
Arch., Engr:,
Designer
Address
City Zll
LICENSED. CC
I hereby"affirm that I am licensed um
000) effof, Division 3 of the Business anc
ect-` '
No. 15,®23
11LDING: TYPE CONST. OCC: GRP.
P. Numbe'r`.'"'"
Igal Description
oject Description' 138'. o 5 e . high garden
walk:. .
City
Lic. # 2$45Sq. Ft. No No. Dw.
- Size Stories Units
New ❑ Add ❑ Alter Repair ❑ Demolition ❑
Tel.
State
Lic. #
I'S DECLARATION
ns of Chapter 9 (commencing with Section
is. Code„ and my license is in full force and -
al P, trT4, 1
f OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the ContractorslLicense 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 violafbn of Section 7031.5 Dy 'any applicant for a permit
subjects the applicant to a civil penalty of not more than -five hundred dollars ($500)
O 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 'reprove for the purpose of sale.)
❑ 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 contractors) ficensed 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 certified copy thereof. (Sec. 3800, Labor Code.).
Policy N��./� Company
l�Copy, Is filed with the city. • ❑ Certified 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 perfomiance 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: It, after making this Ce�cate 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,(%X)), IN ADDITION TO THE COST OF COMPENSATION,
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODEi INTEREST,. AND
ATTORNEY'S FEES.
This is a building peirnit when propedy filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 160 days.
I certify that 1 -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
stimated Valuation
$2,188.00
PERMIT
AMOUNT
.Plan Chk. Dep.
Plan Chk. Bal.
Const.
5i. 00
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
54.00-
4.0Q-
REMARKS
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 from Property Line
FINAL DATE INSPECTOR s
Issued by: Date
Validated by: -
I!
Validation-. n M M , F
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBINU FEES
1ST FL. SO. FT. ® $
UNITS
SLAB GRADE
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL. SO. FT. p
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
GAS (ROUGH)
METER LOOP
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
GAS (FINAL)
TEMP. POLE
DRAINAGE PIPING
CAR P. S0. FT.
GROUT
WATER HEATER
WALL S0. FT.
FINAL INSP.
DRINKING FOUNTAIN
SO. FT. ®
WATER SYSTEM
URINAL
ESTIMATED CONSTRUCTION VALUATION $
_$
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
FIRE ZONE ROOFING
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
LATHING
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1 VA c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/.c
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
OBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE ft PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
GROUND PLUMBIII:G
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 APP./ECUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM ��// i��
v�
WATER SYSTEM
GRADING •
cu. yd.
$ plus x$
_$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
� "In
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL