15013 (RER)T
44
'P.O. BOX 1504
Building 79-700 Iris Court 78-495 CALLE TAMPICO
Addri lis LA OUINTA, CALIFORNIA 92253
Mailing
Address Salm .
City Zip Tel.
-lea Qu nta r CA 922-53 .
Contractor
IRog 3nellenberger &' sac.
T reAS6 5 904.idw4lk a # 212
--City Zip
Palm Desert, k 92211 T777-7766
State Lic. City
& Classif..- B 488234 Lic. # 18.58 •.
' Arch., Engr.,
Designer
Address Tel.
"City Zip State
Lic. #
LICENSEDCONTRACTOR'S DECLARATION
,I hereby affirm that_l,am licensed nder prions qt Chapter 9 commencing with Section
ir7000) of D!visiion 3 of the Busin�eess and Profess�io�ns ode' and m icense is in full force and
lieffect. �*d a� fePt ;+, S Y�
j SIGNATURE DATE
OWNER -BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Susiness and Professions -Code: Any.clty 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 rile 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 Cale, 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 penally of not more than five 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, Bulaness 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. 8, 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.)
0-1, as owner of the property, am exclusively contracting with licensed contractors to corr
struct'the project.•(Sec. 7044, Business and.Professlons 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 contractor(s) 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•lnsure, or.a certificate -of
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Poliic�cyy� No4 Company
I�PCopy is filed with the city, ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed 8 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 -owner
NOTICE TO APPLICANT: ff, after making this Certificate 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 ($100,000), 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.
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
No.- 150-13
BUILDING: TYPE CONST. - OCC: GRP.
A.P. Number
Legal Description
Project Descript{iion—Replace '3 � garage door
With �tJso Window
Sq. Ft. No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation s 1000.00
PERMIT
AMOUNT
Plan Chk. Dep. '
Plan Chk. Bal.
Const.
1.5.00
Mech.
Electrical
Plumbing
INSPECTOR
S.M.I.
Date Permit
Grading
Driveway Enc.
Validation:
Infrastructure
TOTAL
15.00
REMARKS
r`
ZONE:..
BY:. / '� i W I
Minimum Setback Distances: q f.
Front Setback from Center Line i
Rear Setback from Rear Prop. Line j
Side Street Setback from Center Line
- Side Setback from Property Line
FINAL DATE
INSPECTOR
Issued by:
Date Permit
Validated by:
Validation:
J
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. 1 PLUMBIW FEES
1ST FL SO. FT. ® $
UNITS
SLAB GRADE
. 2ND FL. SO. FT. p'
BONDING
YARD SPKLR SYSTEM
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK]
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS f
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
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.
SO. FT. ®c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1% c
SEWAGE DISPOSAL
GAR. FIREWALL
SO.FT.GAR p 3/ac
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
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING X 14
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESJINITIALS
GARDEN WALL FINAL