Loading...
15723 (AR)1 Building 47-360 Ravenna 4'4 Q P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Larry Chazen -&IaiIing Address. 47-305 Ravenna City ! Zip Tel psi. Qtxiit�� 9.2353 - 564"5407 .Contractor Hike Bergen ' Address 7.305 Ravexina City Zip Tel.: La Quints 92253 554--5437 State Lic. City & Classif.. ; � `~ Lic. # Asch: Engr: y ' Designer ' '3112.ng 9. McCallum/LTD 'Address Tel. . 45--190 Club Dr. 360-0250 ICity Zip State i Indian Wells 922'10 Lic. # C7424 LICENSED CONTRACTOR'S DECLARATION { I hereby affimiStliat I am licensed under provisions of Chapter 9 (commencing with Section 7000 of Division 3 oft he,Business and Professions Code, and my license is in full force and er 4effecf_/6 f / Z<_ c SIGNATURE DATE OWNER -BUILDER DECLARATION I hereby affirm that I 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, alter, 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 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 subjects the applicant to a civil penalty of not more than rive hundred dollars ($500). ❑ 1, 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 buildin N0. 15723 . BUILDING: TYPE CONST. OCC: GRP. A.P. Number Legal Description Project Description Addition Sq. Ft. Size - New ❑ Adder Estimated Valuation- PERM aluation ' PERMIT Plan Chk,' Dep. Plan Chk. Bal: Const.Mech. No. No. Dw. -� Stories Units Alter ❑ Repair ❑ :Demolition ❑ $26,,797.00 9 - or improvement is sold within one year of completion, the owner -builder wl11 have the burden of proving that he did not build or bnprove for the purpose of sale.) b* 1, I, as owner of the property, am exclusively contracting with licensed contractors to corn Strutt 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) (tcensed pursuant to the Contractor's License Law.) •❑ 1 am exempt under Sec. B. & P.C. for this reason EI@CtfICa1 Plumbifig ' S.M.1. . Grading Driveway Enc. Date owner 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, ora certified copy thereof. (Sec. 3800, Labor Code) Policy No. Company ❑ Copy is filed with the city, ❑ Certified copy is hereby furnished. subject to the .*Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. ;Minimum Setback Distances: ' TOTAL 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 thp,,wiirk for which this permit is issued, I. shall not employ any erson in any manner so as t&bei me subject to the Workers' Compensation REMARKS `. ws of California. `s AMOUNT to fi d�'- s. Owner :✓ "w - t.-»t---� a ate^* . 4U L U Y e Uk subject to the .*Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. ;Minimum Setback Distances: ' _ Front Setback from Center Line ..-. y Rear Setback from Rear Prop.. -Lin WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND Side Street Setback from �ie� f LI ' 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,.' rCjJ// Side Setback from_Pfope • e' DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. ws of California. `s to fi d�'- s. Owner :✓ "w - t.-»t---� a ate^* NOTICE TO APPLICANT: If,'�affer making this Certificate bf Exemption you should become ZONE: BY: subject to the .*Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. ;Minimum Setback Distances: ' _ Front Setback from Center Line y Rear Setback from Rear Prop.. -Lin WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND Side Street Setback from �ie� f LI ' 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,.' rCjJ// Side Setback from_Pfope • e' DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. a ' FINAL DATE INSP OR This is a buildingproperty permit whenfilled out, sighed and validated, and is subject to g I expiration it work thereunder is suspended for 180 days: I certity that I have read this application and state that the above information is correct. Issued by: Date JJ CCCTTT Pe m1j7 1 agree to comply with all city and county ordinances and state laws relating to building / C construction, and hereby authorize 'representatives -of this city to enter the . above. for inspection mentioned property purposes. Validated by: !J Signature of applicant Date— ate _ n Mailing Mailing Address . Validation: City, State, Zip CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBIW FEES 1ST FL. SQ. FT. ® $ UNITS ROUGH PLUMB. BONDING 2ND FL. SQ. FT. STORAGE TANK YARD SPKLR SYSTEM ' POR. SQ. FT. ® MOBILEHOME SVC. BAR SINK GAR. SQ_ FT. ® POWER OUTLET ROOF DRAINS CAR P. SQ. FT. REINF. STEEL �.3 DRAINAGE PIPING WALL SQ. FT. ® i DRINKING FOUNTAIN. SQ. FT. ® FINAL INSP. URINAL ESTIMATED CONSTRUCTION VALUATION $ WATER SYSTEM WATER PIPING NOTE: Not to be used as property tax valuation LUMBER GR. FLOOR DRAIN MECHANICAL FEES FINAL INSP. WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER VENTILATION 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. SQ. FT. ® c BATH TUB SQ. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SQ. FT. RESID ® 11/4 c SEWAGE DISPOSAL SQ.FT.GAR ® 3/oc HOUSE SEWER 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 6 ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMS /�� SEWER OR SEPTIC TANK ROUGH WIRING DUCT WORK ROCK STORAGE FOUND. REINF. /J� GAS (ROUGH)' METER LOOP HEATING (FINAL) OTHER APP.IEQUIP. REINF. STEEL �.3 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 Q REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL A 2 LATHING MESH ^� INSULATION/SOUND �g FINISH GRADING v FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL Building 4T-360 Raven 31,3 %Address ' vner C. T,itlf 4 *AP Q" P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 failing Address 4 7 --345 RaVenna Cdt�l ,.1.12� nta "P922 53 Tel. -,64--540 JIContractor tiff k: Bnr en Address City Zip Tel. Uinta 92253 564--543'7 State Lic. I City & Classif. �! C,' ^l�' --, I Lic. # Arch. Engr., �_- Designer :'!ling ic:CallUri/ .Tri Address45-130 Club Dr I Tel. 360-0250 City Zip State Indiaia wa].Z�; 1 92,210 1Lic.# C7429 LICENSED CONTRACTOR'S DECLARATION I here%y affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000j of Division 3 of She Business and Professions Code, and my license iS in full force and etfecf. I SiGNATLniE DATE OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License law for the following reason: (Sec. 7031.5,Businoss and Professions Coda: Any city or county which requires a permit to construct, alter, improve, demWlsh, or repair any structure, prior to its issuance also requires the applicant for such permit to file a signed statwnenl that he is licensed pursuant to the provisions of the Conlracilm"a License taw, Chapter 9 (commencing with Section 7000) of ansfan 3 of the Business and Professions Code, or that he fs exorrrpt therefrom, and the basis for tho allegod oxomprion. Any violation of Section 7031-5 by any applicant for a permit subjects the applicant to a civil penally of not more than Ave hundred dollars (S500J. ❑ 1, as owner of the property, or my employees with wages as their solo compensation, will do the work, and the structure is not intended or offered for sale. (Sec. 7044, Bussness and Prolasslons Cade: The Contractor's License Law does net apply to an owner of property who builds at improves thereon arm who does such work himself or through his own employees, prmvkfed Mal such improvements are not Mranded or offered for sate_ n, 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 improve for the purpose of sale.) ❑ 1, as owner of the property, am exclusively contracting with licensed contractors to con- struct the project. (Sec. 7044, Business and Professions Cade: 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 contraclor(s) licensed pursuant to the Contractor's License Law.) ❑ 1 am exempt under Sec. 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 copy thereof. (Sec. 3800, Labor Code.) Policy No Company El 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 tttpr work for which this permit is issued, I shall not employ any pparson in any manner so as la bectime subject to the Workers' Compensation -ws of California. a . kale Owner NOTICE TO APPLICANT, If, after makMg thfa Certificate of Exemption you should become subject to the Workers' Compens Wn 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. This is a building permit when properly filled out, signed and validated, and is subject to 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. 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 BUILDING: TYPE CONST Number Legal Description_ Project Description No. 15723 OCC. GRP Sq. Ft. No. No. Dw. Size Stories Units New ❑ AdXff Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation $ 2 0 r 7 9!. 00 PERMIT AMOUNT Plan Chk. Dep- Plan Chk. Bal. 14 1 - J Const. • e Mech. 4 9l Electrical �. �t . Plumbing 4 5 .: S.M.I. 1.08 Grading Driveway Enc. Infrastructure TOTAL REMARKS ZONE: BY: Minimum Setback Distances: Front Setback from Center Line Rear Setback from Rear Prop. In Side Street Setback from I PLi Side Setback from Proper(y"4 e FINAL DATE Issued by: Validated by: Validation: '\1 CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBINi; FEES 1ST FL. SO. FT. ® 2ND FL. SO. FT. 0 POR. SO. FT. @ GAR. SO. FT. ® CAR P_ SO. FT. WALL SO. FT. @ SO. FT. ESTIMATED CONSTRUCTION VALUATION $ UNITS YARD SPKLR SYSTEM MOBILEHOME SVC. BAR SINK POWER OUTLET ROOF DRAINS DRAINAGE PIPING DRINKING FOUNTAIN URINAL $ WATER PIPING NOTE: Not to be used as property tax valuation FLOOR DRAIN MECHANICAL FEES WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER 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 SO.FT.GAR ® V4c HOUSE SEWER 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 r!j • � I GROUND PLUMBING t r UNDERGROUND A.C. UNIT COLL. AREA �7rr SLAB GRADE F f fi Ilw / ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMS f� SEWER OR SEPTIC TANK ROUGH WIRING DUCT WORK ROCKSTORAGE FOUND. REINF.J GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APP.IEOUIP. REINF. STEEL ,rT f 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 Gar .� �• .L ���� pJ/� � REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATION/SOUNDif FINISH GRADING FINAL INSPECTION f, CERT. OCC. FENCE FINAL INSPECTOR'S 510NATURESIINITIALS GARDEN WALL FINAL