15697 (RR)r
44
I Vista Bonita P.O. BOX 1504 No. 15697
Building 78-495 CALLE TAMPICO
Address 49-657 t 671*6851699 LA QUINTA, CALIFORNIA 92253
•Owner Santa Ro8a Core H.Q.A.
Mailing BUILDING: TYPE CONST. OCC: GRP.
Address 50107 Calle Oaxata
A.P. Number
City Zip Tel.
,ro .Quanta 92253 Legal Description -
ContractorProject Description Instr' ll new poly urethane f'Oart
Bryant L3-niVersa1
Address Zoo: and-coating over exsivtittg built up
3462 La. Campana roof.
City Zip Tel.:
.�'al ..springy 92260 320-6022
State Lic. City
& Classjf36'5357 Lic. # 2293 Sq. Ft. No. No. Dw.
Arch.; Engr.,
Size " Stories Units
Designer. New ❑ Add [I Alter ❑ Repair ❑ . 'Demolition ❑
Address Tel.
City ; • Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm IQ 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 s `
SIGNATURE DATE
OWNER-BUILDER DECLARATION Estimated Valuation w r
I hereby affirm that I am exempt from the Contractor's License Law for the following $14#697.00
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a
permitto construct, after. Improve, demolish, or repair any structure, prior to its issuance also - s
requires the applicant for such permit to rile 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) or '
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 Chk. Dep.
subjects the applicant to a civil penalty of not more than five hundred dollars ($500).
O I, as owner of the property, or my employees with wages as their sole compensation, will Plan Chk: Bal.
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and COrLSt..� e„ �'
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. -
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
or 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- Plumbing
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 contacts for S.M.I.
such projects with a contractors) licensed pursuant to the Contractor's License Law.)
,
D i am exempt under Sec B. 8 P.C. for this reason Grading
Driveway Enc.
Date owner Infrastructure
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate oficonsent to self-insure, or a certificate of
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. a Company!' ` /"
O Copy Is filed with the city. ❑ Certified copy is hereby furnished.
TOTAL
CERTIFICATE OF EXEMPTION FROM REMARKS
WORKERS' COMPENSATION INSURANCE.
(This section need 'not be completed If the permit is for one hundred dollars. IS 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 so as Ao become subject to the Workers' Compensation
Laws of California
Date Owner
NOTICE TO APPLICANT. ti, -after making this Certificate of Exemption youshould become ZONE: - ' BY:
subject to the Workers' Compensation provisions of the "Labor Code, you must forthwith Minimum Setback Distances:
comply with such provisions or this permit shall be deemed revoked.
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 Geni r�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 Llne
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND
ATTORNEYS FEES. / 4�
This is a building permit when properly filled out, signed and validated,.and is subject to FINAL DATE INSPECTOR/�'
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.. Issued-by: Date A, Permit er
I agree to comply with all city and county ordinances and state laws relating to building'
construction, and hereby authorize representatives -ofthis city to -•enter.--the , above-. fJ T J
mentioned property for inspection purposes.. Validated by:
Signature of applicant Date
Mailing Address Validation:
City, State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBIW FEES
1ST FL. SQ. FT. ® $
2ND FL. SQ. FT.
POR. SO. FT. ®
GAR. SO. FT. ®
CARP. SQ. FT.
WALL SO. FT. ®
SO. FT. ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTEM
BAR SINK
I 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 APPJEOUIP.
LAUNDRYTRAY
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.
SQ. FT. ® c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/. c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ac
HOUSE SEWER
REMARKS:
VENTILATION
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
ROCKSTORAGE
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
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL 7d