14655 (RER)3 0
. r
Building
Address 52-675 -Avenida Velasco
Owner
Mailing
AddressSame as above
City Zip Tel.
La. Quinta 92253
Contractor
G.L. Scrivens Construction
.Address . . .. .
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Ktn Ctr. 92561 349--3323
State Lic. City
&Classif. 521353 -B Lic. #•3128
Arch., Engr.,
Designer
Address Tel.
CityZip State
. . Lic. #
+� LICENSED CONTRACTOR'S D5CLARATION .
I hereby affirm that I am licensed under provisions o Chaptec9 (commencing with Section
7000) of Division 3 of the Business and ProfessionsiCode, and my license is in.full force and
effect: ( >*_/* 1,4�'v. I-aJ r`,
1 hereby affirm that I am`exempt from the Contractors License Law for the following
reason: (Sec. _7031.5,Bueness and Professions Code: Any city or county which requires a'
p4tyt� con�stryct, alter, Improve, demolish, or repair any structure, prior to its issuance. also
re ices the Ifcant 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 ($500): .
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,• 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 knprove for the purpose of sale.)
❑ 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.)
❑ 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-irisure, 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, ❑ 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 thg work for which this permit is issued, I shall not
employ anyparson in any manner so as to become subject to the Workers' Compensation
Laws of California.
Date Owner
NOTICE TO APPLICANT: ff, after making this Certificate of Exemption you should become
subject to the Workers" CompensaUon 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 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
No. 14655
BUILDING: TYPECONST; OCC. GRP.
A.P. Number
Legal Description
Project Description Fire Damage
ZONE:
Sq. Ft. No. No. Dw.
Size - - Stories --Units
New ❑ Add.❑ Alter ❑ Repair ❑
Demolition.❑
Estimated Valuation
�2fl.E;flQ..l3�#
i
PERMIT ..
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
207.00
Mech.
1.5600
Electrical
15; ; 00
Plumbing
15.00
S.M.I.
Grading
Driveway Enc.
Infrastructure
SAll.
'A
\
Kt•00
TOTAL
-REMARKS--
REMARKS• -
ZONE: BY:
Minimum Setback Distances:-
Front
istances:Front Setback fromCenter Line
_
Rear Setback from Rear Prop. Line
Side Street Setback from`'Ce.nter•Line
• •Side Setback from Property Lin � E
FINAL DATE INSPEQTOR )
Issued by:' Date v `�ApigrMit
'r0
Validated bv:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBINU FEL'S
IST FL. SO. FT. $
UNITS
COLL. AREA
SLAB GRADE
YARD SPKLR SYST.EiW
2ND FL. SQ. FT. ®
HEATING (ROUGH)
STORAGE TANK
FORMS
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
DUCT WORK
ROCK STORAGE
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
METER LOOP
HEATING (FINAL)
DRAINAGE PIPING
CAR P. SQ. FT.
GAS (FINAL)
WALL SQ. FT.
DRINKING FOUNTAIN
SO. FT. ®
URINAL
ESTIMATED CONSTRUCTION VALUATION $
FINAL 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.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
FINAL INSP.
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
%%
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LAUNDRYTRAY
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. F.T. ® c
BATH TUB
SPARK ARRESTOR
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1+/4 c
SEWAGE DISPOSAL
LATHING
SO.FT.GAR ® 3/ac
HOUSE SEWER
MESH
GAS PIPING
PERMIT FEE
INSULATION/SOUND
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
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./EQUIP.
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. /J �S�
FRAMING �+�
FINAL INSP.
ROOFING 2
%%
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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