0576 + 13334 (BLCK)11111111111111111111145
IE
PERMIT APPLICATION
City of La Ouinta
Department of Building and Safety
• This permit becomes.void i1 work not commenced within 180 days Irom date of issuance. OR, it work has been suspended or abandoned for a period of 180 days.
CERTIFICATE OF EXEMPTION FROM WORKERS COMPENSATION INSURANCE: This section need not be completed it
the.permit is for one hundred ($100) o. less. I certify that in the performance of the work for.which this permit ,is
issued, I shall not employ anyiperson in any manner so as to become subject to the Workers' Compensation Laws of
California.
Date Applicant
NOTICE TO APPLICANT: If, alter making this Certificate of Exemption, you should become subject to the Workers'
Compensation provisions of the Labor Code, you must forthwith comply with such provisions or thispermit shall
be deemed revoked. ' '
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: .
O 1 hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend, will be
made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or
demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap 3.2, Grp 2,Art 2: Sec341. Title8,
0 As owner -builder, 1 will not employ anyone to do work which would require a permit from the Division of
- Industrial Safety, as noted 'above, unless such person has a permit to do such work from that division.
. O Division of Industrial Safety Permit No
. ' Date Applicant
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance
of the work or. which this .permit is issued (Sec. 3097; Civ. C.). ••
Lender's Name
Lender's Address
. I certify that I have read this application and state that the above information is correct. I agree to comply with all r.
. -city and county. ordinances and state laws relating to building construction, and hereby authorize representatives .
of this -county to enter upon the above-mentioned property for inspection purposes.
LICENSED CONTRACTORS DECLARATION: I hereby affirm that .1 am licensed under provisions of •Chapter 9
(commencing with Section 7000) of Division 3of the Business and Professions Code, and my license is in lull force -
and effect. s1
License Class // Lic Number %
NO.
OPERATION
DATE
INSPECTOR
NO.
OPERATION
DATE .I
INSPECTOR
BUILDING APPROVALS.
MECHANICAL APPROVALS
1
Set Back
33
Ventilation. System.. •
2
Ftgs & Frms
34
Plenums. &. Ducts
2A
Slab Grade -
35
Furnace Compart.
3
Steel
-
36
. Inlets & Outlets
4
-.Grout Blocks
-
37
Combustion Air, •
5
• Bond Beams
. .
38 38 •
-, Compressor.
6
Roof Deck
39
AppL Clearance
7
Framing
40
Fire Damper
8
Vents
41
Smoke Detection Device
9
Garage Fire Wall
42
Commercial Hood '
10
Fireplace P.L. MI•
43
Final
10A
Fireplace T.O. MINON
-
ADDITIONAL INFORMATION
(/
`i:- 7 V.
: /
-
•
-
. •
-
SEWAGE. SYSTEM SIZE &.LOCATION
11
Exterior Lath
12
Internal Lath
12A
Drywall
13
Finish Grade
INSULATION -
Thick
• R
Value
7A
Walls (Batts)
12B
Ceiling (Batts)
12C
Ceiling (Blown)
14
Final
PLUMBING
APPROVALS
15
Ground Plumb
16
Water Piping
17
Rough Plumb
18
Vents
19
Sewage Disposal -
20
Sewer
21
Water Heater
•
22
Water Softener
23
Water Service
24
Gas Test
25
Final
Tank - - - - Pit L. Line
ELECTRIC APPROVALS
- REAR OF PROPERTY LINE
26
Power Pole
P/L
P/I
.
27
Conduit•
'28
Service Entrance
'
29
Wiring
29A
Grounding Wire
29B
Bonding
30
Fixtures
31
Service •
32-
Final
STREET NAME
Building
Address
IIIIIIIIIIIIIIIIIIIIIIIII 46
54-420 Ave. Alvarado
44Quint
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
Owner Elenor Shive
Mailing
Address Same
City
La Quinta, CA
Zip
92253
Tel.
Contractor
Tom Stone Masonry
Address.
P.O.
dress -
,O. Bow 1333
BUILDING: TYPE CONST.
No. 13334
OCC: GRP.•
A.P. Number
Legal Description
Project Description 65' of 4' high garden wail
City
• La Quinta, CA
Zip 92253
Tel.
564-2128
State Lic.
& Classif. C--29 494257
City
Lic. #
1228
- -Arch., Engr.,
Designer
Sq. Ft.
Size
Stories -
No. Dw.
Units
New ❑ Add ❑
Alter 0
Repair 0
Demolition 0
Address
Tel.
City
Zip
State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7900) of Division 3 of the Business and Professions Code, and my license is in full force and
effect.
i SIGNATURE DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractors License Law for the following
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
requires the applicant for such permit to file 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 of Section 7031.5 by 'any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars (5500).
❑ 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
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,
provided that such improvements are not intended or offered (or 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 of sale.)
❑ 1, 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 (or
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
❑ I am exempt under Sec B & P.C. for this reason
Date Owner
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. 0 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 thg 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.
Date Owner
NOTICE TO APPLICANT: 11, after making this Certificate of Exemption you should become
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this 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 it 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
Estimated Valuation
$1,191.00
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS
9l-57 V
ZONE. BY -
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback frorn`'Ce ter Line
Side Setback from Pro Line
FINAL DATE
Issued by:
Validated by
Validation:
CONSTRUCTION ESTIMATE
NO.
ELECTRICAL FEES
NO.
PLUMBING FEES
1ST FL.
SO. FT.
SQ. FT.
SQ. FT.
SO. FT.
SO. FT.
SQ. FT.
SO. FT.
VALUATION
@
$
STORAGE TANK
FORMS �jl(J`
UNITS
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF. �A
GAS (ROUGH)
METER LOOP
r . r' f i .
2ND FL.
OTHER APPJEQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
YARD SPKLR SYSTEM
FINAL INSP.
POR
®
GRADING
cu yd
=$
MOBILEHOME SVC.
FINAL INSP.
$ plus x$
BAR SINK
FINAL INSP.
GAR.
@
REMARKS:
POWER OUTLET
FIRE ZONE ROOFING
ROOF DRAINS
CAR P.
@
GAR. FIREWALL
LATHING
MESH
DRAINAGE PIPING
FINISH GRADING
WALL
®
FINAL INSPECTION tH5 —i // 4,pCERT.
OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
DRINKING FOUNTAIN
@
URINAL
ESTIMATED CONSTRUCTION
$
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
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.
SO. FT. RESID ® 1+A c
SEWAGE DISPOSAL
SQ.FT.GAR @ Vic
HOUSE SEWER
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
yn
SLAB GRADE t (J�
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS �jl(J`
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF. �A
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM C/ /)----f if al
( [
WATER SYSTEM
GRADING
cu yd
=$
LUMBER GR.
FINAL INSP.
$ plus x$
FRAMING
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION tH5 —i // 4,pCERT.
OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL