BLCK (14603)Building
Address �2-279 Ave, Navarro
Pete Knudsen
Mailing
Address 552_279 Arte . Nava.
Crit QU].1�t8 ZS2253
Contractor
Owner -Builder
P.O. BOX 1504
No. 14603 -
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number
-3172 Legal Description
Project Description X1100 Garden Mall
Address
City
Zip
Tel.:
State Lic.
City
& Classif..
Lic. #
Sq. Ft. No.
No. Dw.
Size Stories
Units
Arch:, Engr.,
'Designer
New ❑ Add ❑- ' Alter ❑
Repair ❑ - Demolition ❑
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) Division 3 of the Business and Professions Code, and my license is in full force and
tof
effec
SIGNATURE DATE
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OWNER -BUILDER DECLARATION
Estimated Valuation
I hereby affirm that I am exempt from the Contractor's License Law for the following
2 y��T
3941
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 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 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 rive hundred dollars ($500).
Plan Bal.
U
❑ I, as owner of the property, or my employees with wages as their sole compensation, will
.Chk.
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and
'Const.
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 safe. If, however, The building*
or Improvement is sold within one year of completion, the owner-bullder willhave the burden
Electrical '
of proving that he did not build or improve for the purposeof. sale.) . .
O 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 contractors) #tensed pursuant to the Contractor's License Law.)
. S.M.I.
.
Grading
O 1 am exempt under Sec. B. & P.C. for th�reason
Driveway Enc.
I
Date- V/ I t nw„er 1�.F lx,4-
Infrastructure -
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 copy thereof. (Sec. 3800, Labor Code.)
Policy No. Company
❑ Copy is filed with the city.. O Certified copy is hereby furnished.
TOTALU
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed 11 the permit is for one hundred dollars ($100) valuation
or less.)
I certify that in the performance of the work for which this permit is issued, I•shall not
employ any pparson in any: manner so as to become subject to the Workers' Compensation
Laws of California.
Date Owner
NOTICE TO APPLICANT. ti, 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.
Tfils Is a building permit when properly filled out, signed and validated, and is subject to
expiration If work thereundevis suspended for 180 days.
I 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 above-.
mentioned property for inspection purposes.
Signature of applicant Date
City, state,
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:
Ab
Validation:
f s
, I I Nvr
Iii
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBIW FEES
1ST FL. SO. FT. ® $
2ND FL. S0. FT.
POR. SO. FT. ®
GAR. SO• FT• ®
CAR P. SO. FT.
WALL SO. FT.
SO. 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.COOL HOOD
SIGN
WASH ER(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.
SO. FT. ® c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 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 APPJEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM /G
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
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIONATURESJINITIALS
GARDEN WALL FINAL