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CITY OF RANCHO MIRAGE DEVELOPMENT SERVICES BUILDING AND SAFETY DIVISION 69-825 Highway 111, Rancho Mirage, CA 92270 General: 760.202.9253 Inspections: Building@r
(For City Use Only) Building Permit No.: ___ Planning □ Public Works □
BUILDING PERMIT APPLICATION
PROJECT INFORMATION
| Site Address: ________ | Rancho Mirage, California 92270 | |
|---|---|---|
| Residential OR Commercial Description of Work | Est. Project Cost: $______ | |
| New Construction (including ADUs) ✿ Living Area (inc. A/C.) Sq. Ft.: ________ | HVAC Installation/Replacement Electrical Upgrade/New Panel/Sub Panel Water Heater Installation/Replacement Re-Roofing Pool/Spa Window Replacement, Enlarging opening? Yes/No PV Solar/Battery, Upgrading Existing: Yes/No System Size: ________ Battery: ________ | |
| Add. /Expansion Existing Structure, Sq. Ft. ________ | Re-Roofing Pool/Spa Window Replacement, Enlarging opening? Yes/No PV Solar/Battery, Upgrading Existing: Yes/No System Size: ________ Battery: ________ | |
| Conversion (e.g. Garage to living), Sq. Ft. ________ | Window Replacement, Enlarging opening? Yes/No PV Solar/Battery, Upgrading Existing: Yes/No System Size: ________ Battery: ________ | |
| Demolition, Sq. Ft. ________ | Window Replacement, Enlarging opening? Yes/No PV Solar/Battery, Upgrading Existing: Yes/No System Size: ________ Battery: ________ | |
| Other: ________ | System Size: ________ | |
 Note: Covered projects require the CALGREEN minimum 65% diversion of C&D material. No. Mods: ________ No. Inverters: ________ | ||
| a separate C&D Waste Management Plan must be submitted and approved prior to permit issuance. | ||
OWNER INFORMATION
ARCHITECT/DESIGNER INFORMATION
| Name: | |
|---|---|
| Telephone No.: | |
| Email Address: | |
| Mailing Address: |
Name: ___
Lic. No. ___Bus Lic. No. ___ Telephone No.: ___
Telephone No.:
Email Address: ___ Mailing Address: ___
Mailing Address:
___
CERTIFICATION
TRANSPARENCY NOTICE: Some or all of the content contained in this application and its attachments may be subject to disclosure pursuant to the California Public Records Act (Government Code section 6250, et seq.)
Application is hereby made to the Building Official for a permit subject to the conditions and restrictions set forth.
- 1. Each person upon whose behalf this application is made and each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this application agrees to and shall indemnify and hold harmless the City of Rancho Mirage, its officers, agents and employees.
- Any permit issued as a result of this application becomes null and void if work is not commenced within ONE HUNDRED EIGHTY
- DAYS from the date of issuance of such permit.
I certify that I have read this application and state that the above information is correct. I agree to comply with all City and State laws relating to the building construction and hereby authorize representatives of the City to enter upon the above-mentioned property for inspection purposes. I also understand that utilities will not be released until such times as all laws, codes and special conditions are completed and accepted by the City. By signing this application, I attest that the property owner has granted consent to apply for the permit and that the associated plans can be released to the property owner at any time.
Date: __/____/____ Name:
___
BUILDING PERMIT- ASSIGNMENT & ISSUANCE
Site Address: ___
OWNER-BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's License Law for the following reason (Sec.7031.5 California Business and Professions Code(B&PC)): Any City 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/she is licensed pursuant to the provisions of the Contractor's License Law (Ch.9 (commencing with Sec. 7000) of Div. 3 of the B&PC) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violations of Sec. 7031.5 by any applicant for a permit subject to the applicant to a civil penalty of not more than five hundred dollars ($500.00).
I hereby affirm under penalty of perjury, one of the following declarations (SELECT ONE):
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, B&PC: The Contractor's License Law does not apply to any 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 building or improvement is sold within one year of completion, the owner-builder will have the burden of proving he did not build or improve for the purpose of sale.)
I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, B&PC: 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.)
I am exempt under Sec. _____, of B&PC for this reason:
I am exempt under Sec. ___, of B&PC for this reason:
Rancho Mirage, CA 92270
LICENSED CONTRACTOR
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 is in full force and effect.
Name: ___
Lic. No.: _____ Class: _____
Exp. Date: ___
Address: ___
Rep.: _____ Tel. No.: _____
Email: ___
WORKER'S COMPENSATION DECLARATION (AB-443)
I hereby affirm under penalty of perjury, one of the following declarations (SELECT ONE):
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 and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions.
I have and will maintain a certificate of consent to self-insure for workers' compensation, as provided for by Sec. 3700 of the Labor Code, for the performance of the work for which this permit is issued.
I have and will maintain workers' compensation insurance as required by Sec. 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation insurance carrier and policy number are:
Carrier: ___
Policy: ___
Date: ___/___/___ Applicant: ___
Date: ___/___/___ Owner: ___
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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.
CERTIFICATION
I certify that I have read this application and state that the above information is correct. I agree to comply with all City and State laws relating to the building construction and hereby authorize representatives of the City to enter upon the above-mentioned property for inspection purposes. I also understand that utilities will not be released until such times as all laws, codes and special conditions are completed and accepted by the City. By signing this application, I attest that the property owner has granted consent to apply for the permit and that the associated plans can be released to the property owner at any time.
Date: ___/___/___ Name: ___
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