The URL can be used to link to this page

15495 (AR)• V/1� �C� P.O. BOX 1504 No. 15495 Building- 78-495 CALLE TAMPICO Address 47-� LA OUINTA, CALIFORNIA 92253 Owner ..y Address 1535 South b Street. City Zip Tel. San Bernadino 92468 909-381-6€07 Contractor:'. Address Zip ITel.: State Lic. ' - City & Classif. , < Lic. # �� 226 Arch.; Engr., - Designer Fran' k Gonzal£S afid ASSOC. Address Tel. 1336 Bast - Chapman Ave. .714-532-6878 City State .Orange "? _T ip 92666 Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby=affirm that,l'am licensed under provisions of Chapter 9 (commencing, With Section 7000) of'Divisio_3 of the Business and Professions Code,„and-my license is injfulLforce and— ' OWNERBUILDER DECLARATION f r 1 hereby affirm that I am exempt from the Contractors License Law for the following reason: (Sec. 7031.5;Susiness and Professions Code: Any •cfty 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 penally 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, Suisness 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.) ❑ 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) #tensed 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 -insure, or a certificate of Workers Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.) Policy No. Company ❑ Copy is filed with the city. ❑ Certified copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM WORKERS'COMPENSATIONINSURANCE (This section -need -not be completed If the permit is, for one hundred dollars ($100) valuation or less.) +...._ W I-certity that in the.performance of thg 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. 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. 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), WADDITION 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 BUILDING: TYPE CONST. OCC: GRP. A.P. Number Description t Description Add Bansus Room Sq. Ft. Size 235 No.. Stories No. Dw.. Units New<g] Add ElAlter ❑ Repair ❑ 'Demolition ❑ , Estimated Valuation i PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. Const. log.0O,, .: Mech.r�.P,j Electrical _ ?. Plumbing S.M.I. _R2 Grading Driveway Enc. Infrastructure 1-83. 48 TOTAL REMARKS . ZONE: BY: Minimum Setback Distances: Front Setback from Center Line Rear Setback from Rear r p Lin Side Street Setback from Ce ter Line Side Setback from Property Line ) FINAL DATE 1 S ECTORy' ,Issued by: Date Permit Validated by: Validation: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBIW FEES 1ST FL. SQ. FT. ® $ UNITS ' A.C. UNIT 2ND FL. SQ. FT. SLAB GRADE YARD SPKLR SYSTEM POR. SQ. FT. ® MOBILEHOME SVC. BAR SINK GAR. SQ. FT. ® POWER OUTLET ROOF DRAINS CAR P. SQ. FT. ROUGH WIRING DRAINAGE PIPING WALL SQ. FT. ®' DUCT WORK DRINKING FOUNTAIN. SQ. FT. ® GAS (ROUGH) URINAL ESTIMATED CONSTRUCTION VALUATION $ WATER PIPING NOTE: Not to be used as property tax valuation REINF. STEEL FLOOR DRAIN MECHANICAL FEES WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER SERVICE GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED FINAL INSP. LAUNDRY TRAY AIR HANDLING UNIT CFM WATER SYSTEM 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. FT. ® c BATH TUB SQ. FT. @ c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 1Ya c SEWAGE DISPOSAL SQ.FT.GAR ® 3/ec HOUSE SEWER FIRE ZONE ROOFING 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 FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL