14269 (BLCK)t
1 'd#ta
Building 54-700'•Ave. Obregon
Address
Owner.
Alfred R. & A>hhdrea Dodey
Mailing 58fi�
Address '
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
cityba Quinta, C tp 92253 1'771-0559
Contractor +
dw%1�'r/Bui 1 d e r
Address
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BUILDING: TYPE CONST. OCC. GRP.
A.P. Number
Legal Description
Project Description 45' of 6' high block°wall
a
City
Zip
Tel.
State Lic.
City"
& Classif.
Lic. #
Sq. Ft.
No. No. Dw.
Size
Stories Units
Arch., Engr.,
r
Designer
New ❑ Add ❑ Alter ❑-* Repair ❑ Demolition ❑
Address
Tel.
1,
City
Zip
State
Lic. #
' LICENSED CONTRACTOR'S DECLARATION
•
_ I hereby affirm that I am licensed under Drovisions of Chapter 9 (commencingwith Section
7000) of Division 3 of the Business and Professions Code, and my license is in full force and
effect.
SIGNATURE DATE
OWNER -BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractor's License law for the following
`
Estimated Valuation$1,125.00
+
• 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 i
• requires the applicant for such permit to file a signed statement that he is licensed pursuant to
PERMIT
AMOUNT
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 Section 7031.5 by 'any for •
Plan Chk. Dep. '
-
of applicant a permit
subjects the applicant to a civil penalty of not more than rive hundred dollars ($500).
Plan Chk. Bal.
#'
C, 1. as owner of the property, or my employees with wages as their sole compensation, will
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and
Const.
-4
s r • v v
Professions Code: The Contractor's License Law does not apply to an owner of property who
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builds or improves thereon and who does such work himself or through his own employees,
. Mech.
-
provided that such improvements are not intended or offered for sale. If, however, the building ,
• or improvement is sold within one year of completion, the owner -builder will have the burden'.'
Electrical
-,••
of proving that he did not build or improve for the purpose of sale.)
"
O I, as owner of the property, am exclusively contracting with licensed contractors to con- -
Plumbing
' •i
Strutt the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law
,
`'does not apply to an owner of property -who builds or improves thereon, and who contracts for -•
S•M•1•
such projects with a contractor($) licensed pursuant to the Contractor's License Law.) -
*I t
Grading
' '
am exempt under Sec. - B. & P.C. for this reason
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Driveway Enc.
-
Date Owner
Infrastructure
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WORKERS' COMPENSATION DECLARATION
t
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.
I A rt� A
TOTAL
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CERTIFICATE OF EXEMPTION FROM h � I.,REMARKS
_
WORKERS' COMPENSATION INSURANCE
(This'section need not be completed if the permit is for one hundred dollars (E 100) valuation
/
or less.)
I certify that in the performance of the work for which this permit is issued, I shall not
i - /
employ any person in any manner so as to become subject to the Workers' Compensation
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Laws of California.
5
Date Owner•
NOTICE TO APPLICANT: n, after making tris Certificate of Exemption you should become
'ZONE:
' / / I -
BY:
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith y
comply with such provisions or this permit shall be deemed revoked.
,Minimum Setback Distances: U ' -
;'•*
Front Setback from Center Line lJ\
'}
Rear Setback from Rear Prop. Line
•
�- WARNING: FAILURE TO SECURE WORKERS'COMPENSATION, COVERAGE IS UNLAWFUL, AND
Side Street Setback from Center Line
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,
Side Setback from Property Line
DAMAGES AS PROVIDED FORAN SECTION 3706 OF THE LABOR CODE, INTEREST, AND
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ATTORNEY'S FEES. - -
This is a building permit when properly filled out, signed and validated, and is subject to
FINAL DATE
INSPECTOR
r
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.
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.
t
Validated by:
• _ Signature of applicant Date
Mailing Address
Validation:
City, State, Zip
CONSTRUCTION ESTIMATE
ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBINU FEES
tST FL. SO. FT. ® S
2ND FL. SO. FT. @
POR. SO. FT. @
GAR. SO. FT. ®
CARP. 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
BONDING
FLOOR DRAIN
MECHANICAL FEES
FORMS
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APPJEOUIP.
LAUNDRYTRAY
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.
SO. FT. @ c
BATH TUB
SO. FT. @ c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID @ IA c
SEWAGE DISPOSAL
SO.FT.GAR @ 3Ac
HOUSE SEWER
REMARKS:
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 APPJEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
S 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 SIGNATURES/INITIALS
GARDEN WALL FINAL