14906 (RR)Building~ 52--655 AVe' Velasco
Address
Owner
Mailing
Address 52-=655 Ave Velasco
.City Zip
La Qli rota 92253
Contractor
Owner/Builder
Address
lZip
P.O. BOX 1504 No. 14906
78-495 CALLE TAMPICO
LA OUINTA, CALIFORNIA 92253 .
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number
Tel.
564-7319 Legal Description
Project Description' Re—Roof
& Classif. I Lic. #
Arch., En gr.,
Designer
Address Tel.
City'Zip State
Lica#
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) t. of Division 3 of the Business and Professions Code, and my license is in full force and
• effec
SIGNATURE DATE
OWNEWBUILDER 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, 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 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 five hundred dollars (5500).
0 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, 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.)
O 1 am exempt under Sec B. & P.C. for this reason
a�
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 No. Company
O. Copy is filed with the city. 0 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 performance of the 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
aliforniaDate Owner•
• NOTICE TO APPLICANT: If, after making this Certificate of Exemption you. should become.
ZONE: -
- • • BY: '
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
Minimum Setback Distances: -
Sq. Ft.
Size
No.
Stories
No. Dw.
Units
New ❑ Add ❑
Alter ❑
Repair ❑ Demolition ❑
Side Street Setba r Cen
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 fr m Propjy Line
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE .LABOR CODE; INTEREST, AND
L� ''YY�
ATTORNEY'S FEES.
�T
Estimated Valuation680
•0
Ttiis is a building permit when properly.filled out, signed and validated; and is -subject to
PERMIT
AMOUNT
Plan Chk. Dep.
'^
1 certify that I have read this application and state that the above information is correct:
Plan Chk. Bal.
Date Per
1 agree to comply with all city and county ordinances and state laws relating to building
Const.
• UP
Mech.
mentioned property for inspection purposes.
Electrical
Signature of applicant Date
Plumbing
Mailing Address
S.M.I.
City, State, Zip
Grading
Driveway Enc.
Infrastructure,:
TOTAL,
3U • ' U
REMARKS "
• NOTICE TO APPLICANT: If, after making this Certificate of Exemption you. should become.
ZONE: -
- • • BY: '
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
Minimum Setback Distances: -
Front Setback.from Ce in
Rear Setback from op. Lin
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL; AND
Side Street Setba r Cen
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 fr m Propjy Line
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE .LABOR CODE; INTEREST, AND
L� ''YY�
ATTORNEY'S FEES.
�T
FINAL DATE
PECTOR
Ttiis 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:
Issued' by:
Date Per
1 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.
Validated by:
Signature of applicant Date
Mailing Address
Validation:
City, State, Zip
.. _
W
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBIW FEES
IST FL. SQ. FT. ® $
UNITS
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
YARD SPKLR SYSTEM
2ND FL. SQ. FT.
HEATING (ROUGH)
STORAGE TANK
FORMS
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
ROCK STORAGE
FOUND. REINF.
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
HEATING (FINAL)
OTHER APP.IEQUIP.
DRAINAGE PIPING
CAR P. SO. FT. ®
TEMP. POLE
WALL SQ. FT.
DRINKING FOUNTAIN
SQ FT ®
URINAL
ESTIMATED CONSTRUCTION VALUATION $
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
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
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.
SQ. FT. ® c
BATH TUB
SPARK ARRESTOR
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 1Ya c
SEWAGE DISPOSAL
LATHING
SQ.FT.GAR ® VAc
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE LPL.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
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP.IEQUIP.
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:
6 e-
yy
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIONATURESIINITIALS
GARDEN WALL FINAL