14716 (BLCK)Buildin
Address 47-500 Via Montigo
_ Owner
Manns Construction
Mailing
Address .154 E.'Desert Falls Dr.
City Zip Tel.
P.O. BOX 1504 N o . 14 716
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253.
Palm Desert 1.92260 340-3522
Contractor
Stege 'Ellington Masons
Address
68673 ganar43ma Rd.
City Zip Tel.:
CatE;erdral City 32334 320-5481
State Lic. City
& Classif.t-29 457804 Lic. # 3607
Arch., Engr.,
•` Designer
l Address Tel.
:City " Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION '
I her affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7009) of Divisio�33 of_the Qusiness and Professions Code; and my license is in full force and
ef�ect.
SIGNATURE t' , i DATE
OWNEWBUILDER DECLARATION'
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Business 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 81e a signed statement that he Is licensed pursuant to
Me provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Divfslon 3 of the Business and Professions Code, or that -he is exempt therefrom, and the basis
for the allegad exemption. Any. violation of Section 7031.5 by *any applicant for a permit
subjects the appficant to a civil penalty of not more than five hundred dollars ($500).
O 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, Bussness 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 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) licensed pursuant to the Contractor's License Law.) • .
-❑ 1 am exempt under Sec. B. 8 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 copythereof. (Sec. 3800, Labor Code.).
Policy No. Company
❑ Copy 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 ($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 o as to.become subject •to the Workers' Compensation
Laws of California
Date Owne G�
NOTICE TO APPLICANT: ff, alter making. this Certificate of Exemption, you should become
subject to the Workers' Compensation p vis/ons of the Labor Code,you must forthwith
comply with such provisionsor 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
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number
Legal Description �Gaarden�'iio' ]&1
Project Description 5 t X 1.4.1 Duroytall System
Sq. Ft. No. No. Dw.
Size Stories . Units
New ❑ Add•❑ Alter ❑ Repair ❑
Demolition ❑
ZONE: BY: i I �1 i
Minimum Setback Distances:. ;;J61Front Setback frOCenterLinRear Setback froRear. Prop. Line
Side Street Setbac Tom Center Line
Side Setback from P.'rope Tune - -- —
FINAL DATE INSPECTOR
Issued by: Date Permit
Validated by:
Validation:
stimated Valuation
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
$63.00
Mech.
Electrical
Plumbing
S.M.I.
0 50
Grading
Driveway Enc.
Infrastructure
TOTAL
50
REMARKS'.
ZONE: BY: i I �1 i
Minimum Setback Distances:. ;;J61Front Setback frOCenterLinRear Setback froRear. Prop. Line
Side Street Setbac Tom Center Line
Side Setback from P.'rope Tune - -- —
FINAL DATE INSPECTOR
Issued by: Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBIW FEES
IST FL. S0. FT. ® $
UNITS
SLAB GRADE
2ND FL. S0. FT.
BONDING
YARD SPKLR SYSTEM
POR. SO. FT.
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SO. FT.
GAS (ROUGH)
DRAINAGE PIPING
WALL SO. FT.
OTHER APP.IEOUIP.
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.000L HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
FINAL INSP.
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
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 ® 11/4 c
SEWAGE DISPOSAL
GAR. FIREWALL
SO.FT.GAR ® V4c
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 APP.IEOUIP.
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
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL 71