15693 (RR)!So414Q*&
D� �7
P.O. BOX 1504
Buil
din g j�' 1 78-495 CALLE TAMPICO
Addres.49y!9,1_1J§�t,�� .-329,-347LAQUINTA,CALIFO�NIA92253
Owner
"Santa Rosa Cove R.O.A. {
Mailing BUILDING: TYPE CONST.
Address 50-1,07 Calle Oaxaca
City Zip Tel.
Le Quinta 922.53
Contractor Bryant Unf vexs&.l
Address
3462 ala Qampzn4
Cit Zip Tel.:
Pa Slings 92260 320-6024'
State Lic. City
& Classif:. 365357 iLic.# 2293
Arch., Engr.,
- Designer
Address Tel.
City Zip State
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
effect aFP-•oxo%� tsl r'i °'J a ' "',r y
SIGNATURE DATE
OWNER -BUILDER DECLARATION
I hereby affirm that 1 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,, 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 -provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) or
.Division 3 or 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 or 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, Buisness and
Professions Code: The Contractor's License Law does not apply to an owner or 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
or proving that he did not build or improve for the purpose of sale.)
O 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.)
❑ I am exempt under Sec. B. & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
1 hereby affirm that I have a certificate of consent to self -insure, or a certificate•of
Worker's Compensation Insurance, or a certifiedSropy thereof. (Sec. 3800, Labor Code.)
Policy Nom -1 j "^' Company [;r
❑ 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 thg work for which this permit is issued, I shall not
employ any person in any manner sous to become subject to the Workers' Compensation
Laws of California
Date Owner
NOTICE TO APPLICANT: It, 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), IN ADDITION TO THE COST OF COMPENSATION,
DAMAGES AS PROVIDED FOR IN'SECTION 3706'OF THE LABOR CODE, INTEREST, AND
ATTORNEY'S FEES.
Tris is a building permit when property filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days.
1 certify that 1 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 .ab"ova.
mentioned property for inspection purposes:.
Signature of applicant Date
.Mailing Address
City, State, Zip
A.P. Number
No. 15693,
OCC: GRP.
Legal Description
Project Description. Install New Poly Urethane
foam roof and coat.-acr over exsistincz
built-up. rod'
Sq. Ft. No. No. Dw.
Size Stories Units
New ❑ Add ❑' Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation $16v614.00
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTALfi.
fid
REMARKS
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line -
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE INSPECTOR
Issued by: Date Permit
Validated by: A\
Validation:
_ AUG 2 3 1995
. U r
CONSTRUCTION ESTIMATE
3 NO. ELECTRICAL FEES
NO. PLUMBINU FEES
1ST FL. SO. FT. ® $
2ND FL. SO. FT.
POR. SO. FT. ®
GAR. SO. FT. ®
CAR P. SO. FT.
WALL SO. FT. ®
SO. FT. ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC. f
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/a c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ac
HOUSE SEWER
REMARKS:
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./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
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL