10135 (BLCK)Building
Address 54-680 •OEREGON .
•
HARRY CHAPLIN
P.O. BOX 1504 N Q .
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
Mailing
Address P O BOX 2084
City P.L.ip Tel.P.L. DL�.ERT 569-5731
Contractor
STIR COUNTRY CONSTRUCTION
Address
78365 HWY 111, "STE. 166
City:.Zip Tel::
LA QUINTA92253 564-4690
State Lic. City
& Classif. 358739 Lic. # 1787
Arch., Engr., - -
Designer
ILDING: TYPE CONST. OCC: GRP.
'. Number -
Legal Description }
Project Description RETAINING WALL VX 70' -
Sq. Ft. No.
Size Stories
New ❑ Add ❑ - ' Alter ❑
No. Dw.
-Units
Repair Or" :Demolition ❑ '
Address
Tel.
CityJZip
State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
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.
' SIGNATURE DATE
1
OWNER -BUILDER DECLARATION
t
Estimated Valuation
affirm that I am exempt from the Contractor's License Law for the following
-reason:
reason: (Sec. 7031.5,Business and Professions Code: Any city or. county which requires a
1.
1'
permit to construct, after, 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
PERMIT - AMOUNT'
=1'the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of.
. y. 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
Plan Chk. Dep.
subjects the applicant to -a civil penalty of not more than five hundred dollars.($500). `
Plan Chk. Bal.
❑ 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
COr1St.' ey �5 Ci 0
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,
Mech.
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.
EIBCtrICal i -
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-
Plumbing
struct the project. (Sec. '7044, Business and Professions Code: The Contractor's License Law
does not to builds improves thereon, -
-.20-.
apply an owner of property who or and who contracts for
such projects with a contractor(s) licensed pursuant to the Contractor's License Law)
S. M.I.
- ..
Grading
r ❑ I am exempt under Sec. B. 8 P.C. for this reason
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 CompensaI n.lnsurance or a certified copy thereof. (Sec. 3800, LaborCode.)
Policy No. _'. �d'� i i✓� i
r cityCPs�n ,
` Copy. is filed with the . � Certified copy is hereby furnished. t�
'
"�. �J
TOTAL $45.20 t
t CERTIFICATE OF EXEMPTION FROM
REMARKS `'
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100) valuation-
' or less.) r
I certify that in the performance of thg work for which this permit Is issued, I shall not
_
r ; J16S,Vr2,,i iI WIVIA:. G4— i' 610
employ any person in any manner so as to become subject to the Workers' Compensation
Laws of California
a v 6KloI1 A. ♦s s rI, x -
Date Owner
NOTICE TO APPLICANT. if, after making this Certificate of 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.
- - 1 y ,t �;j l
Minimum Setback Distances -y05 ��,f:i`"t �� � � .* - ��r� iGfj i Q _
Front Setback'from-Centlter.Linte
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY
Side Street Setback from Center Line
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.)..'
Side Setback from Property Line
Lender's Name
Lenders Address
FINAL DATE INSPECTOR '
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.
1 certify that I have read this application and state that the above information is correct
Issued by: Date - Permit
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.
Validated by:. '
Signature of applicant •' Date
`
Mailing Address
Validation:
City, State, Zip ,•
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
2ND FL. SQ. FT.
POR. SQ. FT. ®
GAR. SO. FT. ®
CAR P. SQ. FT.
WALL SQ. Ff. ®
SQ 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
BONDING
FLOOR DRAIN
MECHANICAL FEES
FORMS
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APPJEQUIP.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
TEMP. POLE
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.
SQ. FT. ® c
BATH TUB
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 1+/4 c
SEWAGE DISPOSAL
_
SO.FT.GAR ® 3/ac
HOUSE SEWER
VENTILATION
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 APPJEQUIP.
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
_
/ � ®
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION -
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL