15022 (DEMO)P.O. BOX 1504 No. 1502/ t
Building 78-495 CALLE TAMPICO
Address 50-855 Washington .-este • FLA QUINTA, CALIFORNIA 92253
Owner Alex Solomon
Mailing
Address 250 '•'E,. Pa!M Canyon #118
City Zip Tel. "
Palm. Springs . Ii 92262
' Contractor
Lorent C:onstrAidtion
Address -.
3311.5 Victoria Brooke Lace
ffsinore, CA , * . - " - Jzip 925,38 if
State LiaCi
& Classif.. $ 0�:22�7 iLi
864-3809
09)678-9108
'# .3681
Arch.,-Engr.,
Designer
Address Tel.
City Zip State
Lic. # -
LICENSED C6NTRACTOR'S DECLARATION
�� I hereby afflmihat I am lien ,under provisions of,Chapter 9 (commencing with Section
�4eff�eot f gMST �oflhe�Busib' s"aynd Pr�ofgssions Code, and my license is in full force and
'OWNER -BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Bustness and Professions Code: Any city, or, county which requiresa
permit to construct, atter, 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 provis!ons 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 ($500).
❑ I, as owner of the property, or my employees with wages as their sole compensation, will
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and
Professions. Code: The Contractor's License Law does, not apply to an owner of property who -
builds or improves thereon and who does such work himself or through his own employees,
provided. that such improvements are not Intended or offered for sale. If, however, the. building
or Improvement is sold within one year of completion, the owner -builder .will have the burden
of proving that he did not build or Improve for the purpose of sale.).
O 1, as owner of the property, am exclusively contracting with licensed contractors to con-
struct the project. (Sec. 7044, Business and .Professions Code: The Contractor's License Law
does not apply to an owner of property* who builds or improves thereon, and who contracts for
such projects with a contractors) pcensed pursuant to the Contractor's License Law.) .
- O 1 am exempt under Sec - B. & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION /
I hereby affirm that I have a certificate of consent to self -insure, or a certificate.of
Worker'sj°.mpensation Insurance, or a certified copy thereof. (Sec. 3800, Labor.Code.) -
Policy �O Company
Vopy is filed with the city, ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS'COMPENSATION'INSURANCE .
(This section need 'not be completed if the permit is for one hundred dollars ($ 1.00). 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,.afer 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 ($IDO,00O), IN ADDITION TO THE COST OF COMPENSATION,
DAMAGES AS PROVIDED FOR IN SECTION 3708 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 it work thereunder is suspended for 180 days.- .. ,
I certify that I have read this application and state that the above rinformation is correct.
1 agree to comply with all city and county ordinances and state laws relating to building
r construction, and hereby authorize representatives -of this city to enter the above
mentloned property for inspection purposes.
Signature of applicant _ Date
Mailing Address
City, State, Zip
LDING:• TYPE CONST: OCC: GRP.
►.P. Number
.egal Description
IrojectDescription, P]F•�'�'d`mint Sky demolition,
prior
I soul of Asia
Sq. Ft. No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑. Repair ❑• Demolition p
2
Estimated Valuation
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const. '
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
Demol l tion
45.00
TOTAL
45.00
REMARKS
ZONE: BY:
Minimum Setback Distances:' -
Front Setback from Center Line
Rear Setback from Rear Prop: _ e
Side Street Setback from C LI
Side Setback from.Prope e
FINAL DATE INS/P OR
Issued by:. Date `� % rmi `\
Validated by: x
�` ��
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBINU FEES
IST FL. SQ. FT. ® $
2ND FL. SQ. FT.
POR. SO. FT. ®
GAR. SO. FT. ®
CARP. SO. FT.
WALL SQ. FT.
SO. FT. ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
BONDING
FLOOR DRAIN
MECHANICAL FEES
FORMS
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APP./EQUIP.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
TEMP. POLE
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 ® 11/4 c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/sc
HOUSE SEWER
REMARKS:
VENTILATION
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE [PL!.CK.FEIE
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.
FRAMING
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING '
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION 3"-T
Ziff-
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL