9697 (BLDG)Building
Owner
4
P.O. BOX 1504 No.
78-105 CALLE ESTADO
51-296 Guatemala LA QUINTA, CALIFORNIA 922153 UL
lur)e Garcia BUILDING: TYPE CONST.—OCC . GRP.:
mailing
Address
City I zip ITel.
Contractor
. Ronc,-*Ln Construction
Addre
49351 Goldenrod Lan
City Zip Tel.:
P.D. 92260 568-1772
State Lic. City
&CIassif. 449822 Lic. #
Arc�., Engr.,
Designer
Address -TT-e TI
City Zip State
I . I Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
700 -the Business and Professions Code, and my license is in full force and
ef?
f �
c�of Division 3 of
GNATU DATE
OWNER-13UILDER DECLARATION
I hereby affir ' m that I am exempt from the Contractor's License Law for the following
-�'reason: (Sec. 7031.5,Buslness and Professions Code: Any 'city 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 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 1, 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.)
0 1, as owner of the property, am exclusively contracting with licensed contractors to corv.
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 contractor(s) licensed pursuant to the Contractor's License Law.)
0 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's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Poli�y No. comparry
0 py is filed with the city. . 0 Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed N the permit Is for one hundred dollars ($100) valuation
or less.)
I certify that in the performance of thp work for which this permit is issu ed, 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., If, 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.
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, Civil Code.)
Lender's Nam
Lender's Address
This is a building permit when property 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. information is correct.
I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representat ives -of this City to enter the -above-
mentioned property for inspection purposes.
Signature of applicant -Date
Mail! ' ng Address
City, State, Zip
9697
A.P. Number
Legal Description
Project Description
FIRE
DAKAGE
Sq. Ft_ 11()o
Size
No.
Stories
No. Dw.
Units
New 0 Add 0
Alter 0
Repair 0 Demolition 0
Estimate d Valuation
91600
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
'117.00
Mech.
Electrical
Plumbing
S.M.I.
1.00
Grading
Driveway Enc.
Infrastructure
TOTAL
118.00
REMARKS
J 0 V,�,�Iiuf6Z 3
:-ZONE: BY:
I
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Pr6p. Line'
Side Street Setback from Center Line
Side Setback from Property Line
4 1 - .
FINAL DATE —INSPECTOR
Issued by: —Date_Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. @ $
UNITS
COLL. AREA
SLAB GRADE
YARD SPKLR SYSTEM
2ND FL. SQ. FT. @
HEATING (ROUGH)
STORAGE TANK
FORMS
MOBILEHOMESVC.
BAR SINK
POR. SQ. FT. @
DUCT WORK
ROCK STORAGE.
GAR. SO. FT. @
POWER OUTLET
ROOF DRAINS
METER LOOP
HEATING (FINAL)
DRAINAGE PIPING
CAR P. SO. FT. @
GAS (FINAL)
WALL SO. 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.
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
ROOFING
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
VENTILATION
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET
COMPRESSOR HP
POLE, TEWPERM
MLAVAT'ORY
HEATING SYST�M FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER. B.T.U.
SO. FT. @ c
8 T
BATH TUB
SO. FT. @ c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID 0 1 V4 c
SEWAGE DISPOSAL
SQ.FT.GAR @ 3/4c
HOUSE SEWER
j
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL F9ES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE ELECT.FEE
SMIFEE 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
FINAL INSP. 0141 f
-914LI
$_plus_x$_=$
GRADING
_cu.yd.
LUMBER GR.
FRAMING co
FINAL INSP.
ROOFING
L
L
geot rc
0-12
REMARKS:
VENTILATION
FIRE ZONE ROOFING:
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
'G—
LATkNj -262
MESH
INSULATION/SOUND/
"12
FINISH GRADING
FINAL INSPECTION -
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATUREWINITIALS
GARDEN WALL FINAL