HomeMy WebLinkAboutB34301 - CAMINO SAN MIGUEL 4356ALy ,
CITY OF PALM SPRINGS
BUILDING PERMIT
DATE PLAN CHECK PLAN CHECK CASE B E M P EP
SUBMITTED p 4 O 1 9 8 NUMBER FEE p. p p NUMBER PERMITSX
Owner Addross ne State Uc.Number
Isabel Cuhney same 772-1934
Contractor Address Phone State Lk.Number
Paul Davis S st. 68555 Ramon Cathedral City, Ca
Architect Address
Total value of work 2 ,000.00
Sewer Agreement#
Engineer Address
SchoolFse
Fbrturo UnitsLot#Block# Traci Building AddressBuilding Permit
38 VALVISTA 4356 CAMINO SAN MIGUEL 111-3211 45.00LotSizeZoneHeightOccupancyA.A.No. Total Area Plan Check
100*083 RIC 1t1-3807 0. 00
Front Side Side Rear Parcel Number 3MIP Taxetbck8A8
Constructed 680-083-008 0.00
SgU8Te Building Garages/Carports Roofed Patio/Porch Microfilm
Footage 0 0 0 111-3431 2. 60UseofbuildingSMIPTypePermitTypeCost.Type Firo Spdnider Units New Sew Cn Permit issuance
single family MSC 0 0 111-3218 15.00Describeworkindetail:
Construction Tax
Demo and investigation of fire damaged garage. t11-3130 0.00
Dbl.Fee/Rmw/Mist.
111-3288 0.00
Const.Permit
111-3215 0. 00
Sewer Inspection
Special Conditions:
11 t-3214 0. 00
Sewer Main
342-3642 0.00
Sewer Agreement
T&A 0.00
Sewer Connection Fee
DO NOT CONCEAL OR COVER ANY CONSTRUCTION UNTIL THE WORK IS INSPECTED 342-3641
0. 00
IMPORTANT Drainage Fee
The issuance of this permit shall not be held to be an approval of the violation of any provisions of any
0.00TUMFFeecityorcountyordinanceorstatelaw.
134-3788 0.00
Inspections of work are subject to an approved set of plans being on the job. Changes to plans are not Misc.Filing Fee
to be made without permission of the Building and Safety Divisions.
0.00
The owner and/or contractor is responsible for establishing all property lines.Ali utilities must be
Public Arts Fee
underground.550-36M
0. 00
Planning Fee
This permit will expire if work is not started in 120 days or if more than 180 days elapses between 111-3W6 0.00inspections.
I certify that I am familiar with all requirements of the City of Palm Springs as they apply to this 0.00
permit and understand that these requirements must be completed prior to final inspection and that no
certification of occupancy will be issued until such time as these requirements are met. I certify that 0.00Ihavereadthisapplicationandstatethattheinformationistrueandcorrect.
TOTAL FEE 62 .60
OWN / TOR/AGENT DATE ISSUED BY
Lh s a Buildi Permit when properly filled out,signed and validated,and is not transferable.
INSPECTORS COPY 111PERMIT NUMBER B 34301
JOB CARD
GENERAL BUILDING INSPECTIONSe +i Building&Safety Tem PoleCITYOFPALMSPRINGS
p
M
Setbacks Insulation
C+urcaM Pad Certification Drywall
Ground Plumbing Gas PresOWNERIsabelCuhneyDATE04/01/98 Footings
ADDREss 4356 CAMINO SAN MIGUEL PERMrr#
Sewer(Sketch on reverse side)
34301 Roof Nail
Planning ReleaseSWIMMINGPOOLSOutsideWrapeel,ounding,Setbacks Fire Release
A C./Htg Ducts
Underground Piping/Elect Eng.Release
Top-out Plumbing GFinal,Gas Pres,Housing,Energy Final as
Rough Electric Final Electric
ming
ean,Patch,Flash Roof Final
Fra
C.O.Issued
Fireplace Figs Fireplace BB
Masonry Wall Figs Masonry Wall BB
ii
CITY
OF
PALM
SPRINGS
V30)
INSURANCE/
LICENSE
DECLARATION
PERMIT
NO.
WORKER'
S
COMPENSATION
DECLARATION
LICENSED
CONTRACTORS
DECLARATION
I
hereby
affirm
under
penalty
of
perjury
one
of
the
following
declarations:
I
hereby
affirm
that
I
am
licensed
under
provisions
of
Chapter
9 (
commencing
with
Section
7000)
of
Division
3
of
the
Business
and
Professions
Code,
and
my
license
I
have
and
will
maintain
a
certificate
of
consent
to
self-
insure
for
workers'
is
in
full
force
and
effect.
compensation,
as
provided
for
by
Section
3700
of
the
Labor
Code,
for
the
performance
License
Class
X
Expires /-
5'
o-
577.
of
the
work
for
which
this
permit
is
issued.
License
No.
9
I
have
and
will
maintain
workers'
compensation
insurance,
as
required
by
Section
Contractor
c_
4„" ,
s
S- ,„
3700
of
the
Labor
Code,
for
the
performance
of
the
work
for
which
this
permit
is
issued.
My
workers'
compensatio
c
met
and
policy
number
are:
OWNER-
BUILDER
DECLARATION
Carrier:
c ,,
ZrZ
Policy
Number:
S'
F/
t
Exp.
72,_
I
hereby
affirm
that
I
am
exempt
from
the
Contractor'
s
License
Law
for
the
This
section
need
not
be
completed
if
the
permit
is
for
one
hundred ($
100)
or
less.)
following
reason (
Sec.
7031.
5,
Business
and
Professions
Code:
Any
city
or
country
I
certify
that
in
the
performance
of
the
work
for
which
this
permit
is
issued,
I
shall
which
requires
a
permit
to
construct,
alter,
improve,
demolish,
or
repair
any
structure,
not
employ
any
person
in
any
manner
so
as
to
become
subject
to
the
workers'
prior
to
its
issuance,
also
requires
the
applicant
for
such
permit
to
file
a
signed
statement
compensation
laws
of
California,
and
agree
that
if
I
should
become
subject
to
the
that
he
is
licensed
pursuant
to
the
provisions
of
the
Contractor'
s
License
Law (
Chapter
Workers'
compensation
provisions
of
Section
3700
of
the
Labor
Code,
I
shall
forthwith
9 (
commencing
with
Section
7000)
of
Division
3
of
the
Business
and
Professions
Code)
comply
with
those
provisions.
or
that
he
is
exempt
therefrom
and
the
basis
for
the
alleged
exemption.
Any
violation
of
n
01"
ate:
Section
7031.
5
by
any
applicant
for
a
permit
subjects
the
applicant
to
a
civil
penalty
of
D _
Z--/
lk
Applicant
not
more
than
five
hundred
dollars($
500.):
I,
as
owner
of
the
property,
or
my
employees
with
wages
as
their
sole
WARNING:
FAILURE
TO
SECURE
WORKERS'
ENS
ON
COVERAGE
IS
compensation,
will
do
the
work,
and
the
structure
is
not
intended
or
offered
for
sale(
Sec.
UNLAWFUL,
AND
SHALL
SUBJECT
AN
EMPLO
ER
TO
CRIMINAL
PENALTIES
044,
Business
and
Professions
Code:
The
Contractor'
s
License
Law
does
not
apply
to
an
AND
CIVIL
FINES
UP
TO
ONE
HUNDRED
THOUSAND
DOLLARS ($
100,
000),
IN
owner
of
property
who
builds
or
improves
thereon,
and
who
does
such
work
himself
or
ADDITION
TO
THE
COST
OF
COMPENSATION,
DAMAGES
AS
PROVIDED
FOR
through
his
own
employees,
provided
that
such
improvements
are
not
intended
or
offered
IN
SECTION
3706
OF
THE
LABOR
CODE,
INTEREST
AND
ATTORNEY'
S
FEES.
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
improve
for
CONSTRUCTION
LENDING
AGENCY
the
purpose
of
sale.).
I,
as
owner
of
the
property,
am
exclusively
contracting
with
licensed
I
hereby
affirm
that
there
is
a
construction
lending
agency
for
the
performance
contractors
to
construct
the
project (
Sec.
7044,
Business
and
Professions
Code:
The
of
the
work
for
which
this
permit
is
issued. (
Sec.
3097
Civ.
C.).
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
Lender'
s
Name
Contractor'
s
License
Law.).
Lender'
s
Address
I
am
exempt
under
Sec.
B &
P.
C.
for
this
reason
I
certify
that
I
have
read
this
application
and
state
the
above
information
is
correct.
I
agree
to
comply
with
all
city
and
county
ordinances
and
state
laws
relating
to
building
Owner
Date
construction,
and
hereby
authors
representatives
of
this
city
to
enter
upon
the
above-
mentio
roperty
for
inspection
purposes.
Si
t
e
App
cant
or
Agent
Date
Indemnity Agreement
Building Permit No. f)——l
Permit holder hereby agrees to indemnify and defend the City, its officers, agents and employees
against and will hold and save each of them harmless from, any and all actions, suits, claims,damages to persons or property losses, costs, penalties, obligations, errors, omissions orliabilities (herein "claims or liabilities") that may be asserted or claimed by any person, firm or
entity arising out of or in connection with the location, construction, maintenance, relocation orremovalofalltheworkauthorizedbythisbuildingpermit, but excluding such claims or
liabilities arising from the sole negligence or willful misconduct of the City, its officers, agents
or employees, who are directly responsible to the City and in connection therewith:
a) Permit holder will defend any action or actions filed in connection with any
of said claims or liabilities and will pay all costs and expenses, including legal
costs and attorneys' fees incurred in connection therewith;
b) Permit holder will promptly pay any judgment rendered against the City, its
officers, agents or employees for any such claims or liabilities arising out of or
in connection with the work authorized by this building permit, and permit holder
agrees to save and hold the City, its officers, agents and employees harmless
therefrom;
c) In the event the City, its officers, agents or employees is made a party to any
action or proceeding filed or prosecuted against the permit holder for such
damages or other claims arising out of the location, construction, maintenance,
relocation or removal of all work authorized by this building permit, permit
holder agrees to pay the City, its officers, agents or employees, any and all costs
and expenses incurred by the City, including, but not limited to, legal costs and
attorneys fees.
Permit holder:
Name: (print) 51,7c
Signature:
Company. f applicable)
Date:
G:\USERS\BFO\DATA\DOCUMENT\GB\INDEM.AGR