15700 (RR)ET �1~r3'3�31�''.mt P.O. BOX 1504
Building 78-495 CALLE TAMPICO
Address 49-990,980,970,960,950 LA OUINTA, CALIFORNIA 92253
Owner
San4a Rosa Cove H.O.A.
Mailing
Address 50107 Calle Oaxaca
.City La Qu�_nt'P.92253 Tel.
Contractor Bryant € niversal
Address
1462 La Carapana
CityTel.:
Palm Spring Zip 922Gfl 320-G022
State Ljc. City
355.357 Lic.
& Classif. . # 2293
Arch., Engr.,.'
Designer
Address Tel.
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am Iicensed•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
effecic•cr...�.rv-.?Y�4�»'�J.••rb �•+�� .�3 "'.!'''3`
31GNATURE DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 703.1.5,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 file a signed statement that he is licensed pursuant to
the provisions or 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 'he. basis
for the alleged exemption. Any violation of Section 7031.5 by 'any applicant .for a permit
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
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 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 bnprove 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.Professlons Code: The Contractor's License Law
does not apply to an owner of property who builds or improves thereon, and who conlracts for
such projects with contractors) (rcensed pursuant to the Contractor's License Law.)
O.l am exempt under Seca ` 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
Worker's Compensation Insurance, or a certified��ccopy thereof. (Sec. 3800; Labor Code.)
Policy No, Company %ter`.
0 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 tha work for which this permit is issued, I shall not
employ anyperson in any manner so as to become subject to the Workers' Compensation
Laws of California
No. 15700:
BUILDING: TYPE CONST. . 1. OCC: GRP.
A.P. Number
Legal Description '
Project' Description IA'st` ll new poly urethane fort`
roof and coating over exsisti g' = up
Sq. Ft.
Size -
New ❑
r '
No.
Stories
No. Dw.
Units
Add ❑ Alter ❑ . Repair ❑ Demolition ❑
>timated Valuation $21,726.00
PERMIT
AMOUNT
Plan Chk. Dep.
BY: '
Plan Chk. Bal.
Minimum Setback
Const.
$30.00
Mech.
Front Setback from Center Line
Electrical
Plumbing
WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL, AND
S.M.I.
.
SideStreetSetbackfromnterl_ine
Ce
Grading
Driveway Enc.
HUNDRED THOUSAND DOLLAR$,($100,000), IN ADDITION.TO THE COST OF COMPENSATION,
Infrastructure
Side Setback from Property Line— \\-
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND
ATTORNEY'S FEES.
)`II
FINAL DATE
'INSPECTOR'/
7tiis is a buil' g perm)f_ when property filled out, signed and validated, and is subject to
expiration it work thereunderis suspended for 180 days.
TOTAL
$30.00
REMARKS
Date a �� Pe9iV
I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives -of this city to .enter the above-.•
Date Owner
NOTICE TO APPLICANT: 'If, after making this Certificate of Exemption youshould become
subject to the Workers' Compensation provisions or the Labor Code, you must forthwith
ZONE:
BY: '
comply with such provisions or this permit shall be deemed revoked.
Minimum Setback
Distances: _
'
Front Setback from Center Line
Rear Setback from Rear PropLine
WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL, AND
-
.
SideStreetSetbackfromnterl_ine
Ce
SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE
iCe
HUNDRED THOUSAND DOLLAR$,($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
ATTORNEY'S FEES.
)`II
FINAL DATE
'INSPECTOR'/
7tiis is a buil' g perm)f_ when property filled out, signed and validated, and is subject to
expiration it work thereunderis suspended for 180 days.
r y \
L /J
I certify that I have read this application and state that the above information is correct. _
-Issued by:
Date a �� Pe9iV
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-.•
9
mentioned property for inspection purposes.
Validated by:
Signature of applicant Date
\\ Z, /
Mailing Address
Validation:
City, State, Zip
.. .. ...
.. �\
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBIW FEES
1ST FL. SQ. FT. $
UNITS 5
SLAB GRADE
2ND FL. SQ. FT.
BONDING
YARD SPKLR SYSTEM
POR. SQ. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SQ. FT.
GAS (ROUGH)
DRAINAGE PIPING
WALL SQ. FT.
OTHER APP./EQUIP.
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.COOL 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, TEMIPERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES:SERV ENT
SHOWER
BOILER B.T.U.
SO. FT. ® c
BATH TUB
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 1+/a c
SEWAGE DISPOSAL
GAR. FIREWALL
SQ.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
CHEATING (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
'
s
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION 3 r3 9G
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIONATURESIINITIALS
GARDEN WALL FINAL