10100 (BLCK)Building 53-225 OBREGON
Address
Owner
JOE STEMMER
Address 52-425 HERRERA
4
P.O. BO
78-105 CALL
LA QUINTA, CAL
City Zip Tel.
LA QUINTA 1 92253 564-4580
Contractor
OWNER BUILDER
ty lZip
State Lic.I City
& Classif. Lic. #
Arch., Engr.; I
Designer
Address Tel.
City Zip State E.
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencingwith'Section,
t.
7000) of Division 3 of the Business and Professions Code, and my license is in full force'and.'"
effec'
SIGNATURE DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from'the Contractor's License Lawfor the, following
reason: (Sec. 7031.5,Buslness 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 rile 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 o/ Section 7031.5 Dy 'any applicant for a permit
' = SXub%ects the applicant to a c!v!I penalty of not more than five hundred dollars.(5500).
( �,I; as owner of the property, or my employees with wages as -their sole compensation, will
�....:dii the work,•and the structure is not intended or offered -for sale. (Sec. 7044, euisness and
Professions Code: The Contractor's License Law does not apply tq-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 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 o/ sale.).
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-
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 contractor(s) licensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec. B. & P.C: for"this reason
Date. $ " Owner -4 jam`- tee. n� -- r / a'f
v
# 1
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.. ❑ 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 pperson in any manner so as Ito becomesubject`to the Workers' Compensation
Laws Ca(jf a /L `' � f�
Date 7} Owner r�!`„�L....`�"/�
NOTICE TO APPLICANT: If, after making this Certificate` o— I- Eiieinptfon you should become
subject to the Workers' (codtpensation provisions of the Labor Code, you must forthwith
comply with such provisions orfhis permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending' agency for the performance of the
work for which this permit is issued. (Sec. 3097, Civil Code.)
Lender's Name
Lender's Address
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
c �_
t�GCH,rcv
X1504 �-!C No. 10100
E ESTADO C r
IFORNIA 92253
)ILDING: TYPE CONST. OCC: GRP.
P. Number
Legal Description
Project Description BLOCK WALL 20 ° R 61
Sq. Ft. No. No. Dw.
Size Stories , Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation $500
PERMIT ' ` AMOUNT
Plan Chk. Dep. .
Plan Chk. Bal:.
Const. $ 15.00
. Mech.
Electrical
Plumbing oK.I�'
S.M.I. « r. { ..05
Grading
Driveway Enc.
Infrastructure
TOTAL • U
REMARKS
t
ZONE; -BY:
MinimuSetback 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
IST FL. SO. FT. ® $
2ND FL SO. 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
ROUGH PLUMB.
FLOOR DRAIN
MECHANICAL FEES
HEATING (ROUGH)
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
DUCT WORK
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
GAS (ROUGH)
LAUNDRY TRAY
AIR HANDLING UNIT CFM
HEATING (FINAL)
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
BOND BEAM
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1% c
SEWAGE DISPOSAL
LUMBER GR.
SO.FT.GAR ® 31Lc
HOUSE SEWER
FRAMING
FINAL INSP.
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
WATER SYSTEM
$
GRADING
cu. yd.
plus x$
+
_$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
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REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESfINIT1ALS
GARDEN WALL FINAL