10901 (RR)Building 54-055 VelaSCO
Owner Peg Mui3r
Mailing same
Address
City LMinta Z'p92253
Contrac ibintyre Roofing
Address 43612 N. Jackson
Indio
State Lic.
& Classif.
- Arch., Engr.,
Designer
Address
City
92201
C39 601429
LICENSED
I herebyy,affi m that I am licensed
DOOyof..!Wsion3 of the Business.
Zip
P.O. BOX 1504 f No. 10701
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253:
V
Tel- 564'-,4698
342-1466
City
Lic..# 303
Tel.
State
Lic. #
DECLARATION
A Chapter 9 (commencingwith 5
;ode, and my license.is iP'full fdi(
.i` ' ' 4,- OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contiaclofs License law for the following
reason. (Sec. 7031.5,Bustness and Processions Code:
Any city or county which requires a
permit to construct, atter, 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 Piofesstons 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 rive 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
of proving that he did not build or improve 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 Contractors 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
Ihereby affinn 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
El -Copy is filed with the city.. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need -not. be completed it the permit is for one hundred dollars (E 100) valuation .
or less.) '
I certify that in the performance of thg work for which this permit is Issued, I shall not
employ any personin any manner so as to become subject'to the Workers' Compensation
Laws of California
Date Owner
NOTICE TO APPLICANT: lf, after making this Certificate of Exemption You should become
subject to the Workers' Compensation provisions of the Labor Code, you must forthwittr
comply with such provisions or this permit shall be deemed revoked.
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, CivifCode.)
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
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number
Legal Description
Project Description Re—Roof
Sq. Ft.
Size
No. No. Dw.
Stories - Units
New ❑• Add ❑
Alter ❑ Repair ❑ 'Demolition ❑
Estimated -Valuation
200
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
20.00
Mech.' . '
Electrical
Plumbing
SMI
Grading
Driveway Enc.
Infrastructure
_ .� •1 pa o
TOTAL
20.00
REMARKS
t yk p
4 t.�a� +3if f �'Fr �}t•Y `�'{tft-��t�.?�.y �,� :'(� . �9#�3
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
Issued by: Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
SLAB GRADE
2ND FL. SO. FT.
BONDING
YARD SPKLR SYSTEM
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CARP. SO. FT.
GAS (ROUGH)
DRAINAGE PIPING
WALL SO. FT.
OTHER APPJEOUIP.
DRINKING FOUNTAIN.
SO FT ®
TEMP. POLE
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GROUT
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SYSTEM
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN,
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FINAL INSP.
GARBAGE DISPOSAL
FURNACE _UNIT WALL FLOOR SUSPENDED
ILAUNDRYTRAY
AIR HANDLING UNIT CFM
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
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/. c
SEWAGE DISPOSAL
GAR. FIREWALL
SO.FT.GAR ® 3/ic
HOUSE SEWER
LATHING
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
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 APPJEOUIP.
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 O L p
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
�'
FINAL INSPECTION•' � Qa
✓
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESANRIALS
GARDEN WALL FINAL 7d