10889 (AR)Building
P.O. BOX 1504 No. 10889
78- 471 Calle Hue �i 7&105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
Owner _
Mr./Mrs Ren Bilsten
Mailing"
Address
Ci� Zip
Contractor
Gellien Construction Co.
Address_.. .
P. 0. Box 945
City" Zip
La Quinta 92253
State Lic.
B Classif. 577284 B
Arch., Engr.,
Designer
Address
el
564-1187
City
Lic. # 1502
Tel.
City Zip State
- Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7M, of Division 3 of the Business, and , ssions-Code, and my license is in full force and
h.✓
effect. 7 / ..
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 permH to rile a signedstatement 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 app5cant for a permit
'subjects the applicant to a civil penalty of not more'than five hundred dollars ($500). '
❑. 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 him all or through his own employees,
provided that such improvements are not intended or offered for sate. 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 Improve for the purpose of sale.) . -
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-
struct the project. (Sec. 7044, Business and Professons Code: The Contractor's License Law
does not apply to an owner of property who builds or knprovas thereon; and who contracts for•
such projects -with a contractor(s) licensed pursuant to the Contractor's License Law.) -
0•1 am exempt under Sea B. & P.C. for this reason
I
Date Owner
WORKERS' COMPENSATION DECLARATION
1 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.)'
Polity No. Company `
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 the work'for'which 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 f
Date`'` F J'ii Owner Nell /}t17�
NOTICE TO APPLICANT: If, after making this - Certificate of Exemption you should become
subject. to 10 Workers' Compensation Provisions of the Labor Code,' you must* forthwith
comply with such provisions or this imif shall be deemed revoked.
4
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of the
work for which this permit 1s issued. (Sec. 3097, Civil Code.)
Lender's Name
Lender's Address
. This is a building'permil 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 Ao enter the above-.
mentioned property for inspection purposes.
Signature of applicant Date
Mailing Address
City, Slate, Zip
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number
Legal Description
Project Description
Zoom Addition
Sq. Ft. 343
Size -
No. No. Dw.
Stories Units
New ❑ Add ❑
Alter ❑ Repair ❑
Demolition ❑
Estimated Valuation
25,004.70
PERMIT
AMOUNT
Plan Chk: Dep.
Plan Chk. Bal.
168.03
Const.
258.50
Mech.
': %'-
15.0€3
Electrical
. -25.00
Plumbing
33 . G0
S.M.I.
2.60
Grading
-Driveway Enc.
Infrastructure
TOTAL
50 2.13
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:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $'
2ND FL SO. FT.
POR. SO. FT. ®
GAR. SO. FT. ®
CAR P. SO. FT.
WALL SO. FT. ® J
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
ROUGH PLUMB. BONDING
FLOOR DRAIN
MECHANICAL FEES
FORMS
WATER SOFTENER
VENT SYSTEM. FAN, EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DIS H)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE, . UNIT WALL FLOOR SUSPENDED
OTHER APPJEQUIP.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
r
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
FINAL INSP.
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1% c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ic
HOUSE SEWER
VENTILATION
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PLCK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE - PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR'
SETBACK
GROUND PLUMBING P DERGROUND
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. REIN
GAS (ROUGH) METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REIN F. STEE
GAS (FINAL) TEMP. POLE
GROUT
WATER HEATER SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM'
GRADING
cu. yd. .
$ plus x$
_$
LUMBER GR.
FINAL INSP.
FRAMING / 2G//�
FINAL,INSP. Z rf
ROOFING
� G J7
^� � /� � �
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR -
GAR. FIREWALL
HINGs 2C�
MESH
INSULAT16MSOUND
FINISH GRADING
• FINAL INSPECTIOtY7
v
CERT. OCC.
FENCE FINAL.
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL