14799 (BLCK)Building
Address 55--120 Inverness
Albers I111'C
Mailing
Address P.O. Box 3656
City Zip
La.QLinta 92253
Contractor
'-Hendre'n'Ci5hstruction
Address
P.O. Box 1804
city -La 0.uintaZip92253
P.O. BOX 1504 N Q .
78-495 CALLE TAMPICO
LA OUINTA, CALIFORNIA 92253 '
BUILDING¢ TYPE CONST. OCC: GRP.
A.P. Number
Tel.�� .v-jc a;
Legal Description T'>a1r i;bn T *14''r
Project Description
6'#'" @ 225' t
564--5075
State Lic.
City
& Classif: 190400
Lic. #
Sq. Ft. No.
No. Dw.
Arch., Engr.,
Size Stories
Units
Designer
New ❑ Add ❑ Alter ❑
Repair ❑ Demolition ❑
Address
Tel.
✓
City
Zip
State
Lic. #
LICENSED CONTRACTOR'S DECLARATION -- -777-77—
I
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with -Section
7000) Division 3 of the Business and Professions Code, and my license is in full force and '
• '
t.of
effec-
SIGNATURE - - "' '-^+..,_ DATE
OWNER -BUILDER DECLARATION'
Estimated Valuation
I hereby affirm that I am exempt from the Contractor's License Law for the -following
reason: (Sec. 7031.5, Business, and Professions Code: requires • a
_Any.crtyror,�county"'whlch
- permit to construct, atter, improve, CemolishrorWjiafi ahylstiucfure, prior to its Issuance also
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) of
-
-
Division 3 of the Business and Professions Code, or that. he is exempt therefrom, and the basis
for the alleged Any Section 7031.5. 'any
Plan Chk. Dep.
exemption. violation of by applicant, for a, permit
subjects the applicant to a civil penalty of not more than five hundred dollars ($500)..
_
-
Plan Chk. Bal.
❑ 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
COr1St.{
�,� 00
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
+ j�
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-
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 contracts for
such projects with a contractor(s) Licensed pursuant to the Contractor's License Law.)
S.M•I.
-
Grading
❑• I am exempt under Sec. B. 8 P.C. for this reason
Driveway Enc.
Date owner
Infrastructure
'
WORKERS' COMPENSATION DECLARATION
le hereby affirm that I have a certificate of consent to self -insure, or a certificate of ^
Workr's Compensation Insurance,.or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. Company
❑ Copy is filed with the city. ❑ Certified copy Is hereby furnished.
TOTAL
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE -
(This section need not be completed if the permit is for one hundred dollars (8100) valuation
or less.)
I certify that in the performance of thg work forwhich 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: 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.
! 4,
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 ($IDO,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 it 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
REMARKS
ZONE: BY:
Minimum Setback Distances:'
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
e a k from Property Line
INSPECTOR
Permit
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBINU FEES
IST FL. SO. FT. ® $
UNITS
SLAB GRADE
2ND FL. SO. FT. p
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 APPJEOUIP.
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
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FINAL INSP.
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
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 ® 3/ac
HOUSE SEWER
LATHING
GAS PIPING
PERMIT FEEPERMIT
FEE
PERMIT -FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEEPL.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
F ,UND. 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.
.$—Plus—x$—=$—
plusx$=$ROOFING
LUMBER, GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
-
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL