15828 (AR)f
4
P.O. BOX 1504
Building '� 78-495 CALLE TAMPICO
Address 50-180 Vista Fontana LA QUINTA, CALIFORNIA 92253
Owner
.dames Halper
Mailing BUILDING: TYPE CONST. OCC: GRP.
Address
. a�'�tEc���i�9L7�i•£� „� A.P. Number
City Zip Tel.
La a-int-a 92253 Legal Description
Contractor Owner/Builder Sublist attached Project Description Addition
Address
City Zip Tel.:
State Lica City
& Classif.. Lic. # Sq. Ft. 933 No. No. Dw.
Arch., Engr. Size Stories Units
� '
Designer W.R. Hanes AIA New ❑ Add ❑?Alter ❑ Repair ❑ Demolition ❑
Address Tel.
78-750 St. ThoinaIs ;fix. 3€0-'9039
City Zip State
Bermuda Dunes 92201 Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of the Business and Professions Code, and my license is in full force and k
effect.
y,
SIGNATURE DATE
OWNER-BUILDER DECLARATION Estimated Valuation $64,891.00
I hereby affirm that I am exempt from the Contractor's License Law for the following f
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 file a signed statement that he is licensed pursuant to - PERMIT, AMOUNT'
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 . Plan ChkC Dep. _;-_'•
subjects the applicant to a civil penalty of not more than five hundred dollars ($500).,,�� 0, [�
❑ I, as owner of the property, or my employees with wages as their sole compensation, will Plan Chk. Bal. $ 3S8` . 88
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and Const. vy5� .N
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, Mech. $ 83..00 .
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 Electrical $ ol..66
of proving that he did not build or improve for the purpose of sale.) 1
❑ 1, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing $145.50
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 S. M.I. $ 6.4-9
such projects with a contractor(s) (Icensed pursuant to the Contractor's License Law.)
Grading ;v1D
❑ I am exempt under Sec. B. 8 P.C. for this reason
Driveway Enc.
Date Owner ��'>-...,� Infrastructure
WORKERS' COMPENSATION DECLARATION
I hereby affirm that 1 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.)
Policy No. I
Company
O Copy is filed with the city. ❑ Certified copy is hereby furnished:
TOTAL $1,263.03
CERTIFICATE OF EXEMPTION FROM REMARKS
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred .dollars ($100) valuation
orless.)
. I certify 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: n, -after making this Certificate of Exemption you should become ZONE: BY:
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shah be deemed revoked.- Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL, AND Side Street Setback from Center Line
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, Side Setback from Property Line
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND - - - ^ `•1
ATTORNEY'S FEES. FINAL DATE INSPECTOR
This is a building permit when properly filled out, signed and validated, and is subject to
ti
expiration if work thereunder.is suspended for 180 days. t
I certify that I have read this application and state that the above information is correct. Issued by:_' - Date
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-.. Uminn
mentioned property for inspection purposes.Validated by:
Signature of applicant Date
Mailing Address Validation:
City, State, Zip f
By
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
2ND FL. SQ. FT.
POR. SO. FT. ®
GAR. SO. FT. ®
CARP. SQ. FT.
WALL SQ. Ff.
SQ. 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.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APPJEQUIP.
LAUNDRYTRAY
AIR HANDLING UNIT CFM
TEMP. POLE
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET
COMPRESSOR HP
POLE, TEMIPERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SQ. FT. ® c
BATH TUB
FINAL INSP.
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® I% c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ac
HOUSE SEWER
VENTILATION
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO REE
MECH.FEE - PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
LIND PLUMBI
INDERGROUN Q—
A.C. UNIT
COLL. AREA
LAB GRADE l
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
OUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM.
WATEF SYSTEM
GRADING
cu. yd.
$ Plus—X$—=$
LUMBER GR. , .
FINAL INSP.
FRAMING,
FINAL INSP.
ROOFING
c�
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
/
I NSULATIONISOUN D/ 0
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES11NITIALS
" GARDEN WALL FINAL