BLCK (07324)54195 Avenida Madero
07324
Building 54-195 Madero
Address
___ Richard Siddons
T4t!t 4 4 Q"
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
Mailing
Address 76-724 Daffodil Drive
"yPalm Desert ZIP 92260 1 T 445-1282
Contractor
{timer
City lZip Tel.
State Lic.I City
& Classif. Lic. #
Arch., Engr.,
Designer
Address Tel.
City IZip I State I
Lic. #
_'-LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that 1 am licensed undec'provisions of Chapter 9 (commencing with Section
effect.
bivision 3 of'the business and Professions Code, and -my license is in full force and
effec
_SIGNATURE Y S- - DATE
OWNER -BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,11usiress and Professions Code: Any city or county which requires a
Permit to construct, after, irprove, demo4sh, or repair any structure, prior to its issuance also
requires the appicad for such permft to tie a sued statement that he is licensed pursuant to
the provisions of the Contractors 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 exerrptioa Any violation of Section 7031.5 by 'any applicant for a permit
subjects the applicant to a civilpenafty of not more than five hundred dollars ($500).
❑ 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 Contractors 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 rrpiovements 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 Oat he did not build or inprove for the purpose of sale.)
❑ 1, as owner of the properly, 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 bolds or improves thereon, and who contracts for
such projects with a contractor(s) icensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sem a- & P.C. for this reason
Date owner
WORKERS' COMPENSATION DECLARATION
1 hereby affirm that I have a certificate of consent to self -insure, or a certificate of
Workers Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No Company
❑ Copy is filed with the city. ❑ Certified copy is hereby fumished.
CERTIFICATE OF EXEMPTION FROM
WORKERS'COMPENSATIONINSURANCE
(This section need not be Co pleted 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
aliforniaDateowner
NOTICE TO APPLICANT. X. after making Oris Certificate of Exemption you should become
subject to the VAukers' Conpasabon provisions of the Labor Code, you must forthwith
comply wth such Provisions a Osis perm) shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
1 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 property filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days.
I certify that 1 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 authortre representatives -of this city to enter the above-.
mentioned property for inspection purposes
Signature of applicant Date
Mailing Address
City, state, zip
No. 47324
11LDING: TYPE CONST. OCC. GRP. -
P. Number. 774"292"021
Description
t Description 2-f0et x IRY—foot Retaining Hall
ZONE: BY:
Minimum Setback 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 3/22%90Permit
Validated by:
Validation:
Sq. Ft.
Size
No.
Stories
No. Dw.
Units
New ❑ Add ❑
Alter ❑
Repair ❑ Demolition ❑
Estimated Valuation
$1,500
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
t4S
Mech.
Electrical
Plumbing
S.M.I.
V
Grading
Driveway Enc.
Infrastructure
i
TOTAL
$45.14
REMARKS,;t.,1:?
ZONE: BY:
Minimum Setback 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 3/22%90Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL SO. FT. ® $
UNITS
COLL AREA
SLAB GRADE
ROUGH PLUMB.
YARD SPKLR SYSTEM
2ND FL SQ. FT.
HEATING (ROUGH)
STORAGE TANK
FORMS
MOBILEHOME SVC.
BAR SINK
POR. SQ. Ff. ®
DUCT WORK
ROCK STORAGE
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
METER LOOP
HEATING (FINAL)
DRAINAGE PIPING
CAR P. Sp. FT.
GAS (FINAL)
WALL SQ. FT.
DRINKING FOUNTAIN.
SOFT®
WATER HEATER
URINAL
ESTIMATED CONSTRUCTION VALUATION $
FINAL INSP.
WATER PIPING
NOTE Not to be used as property tax valuation
WATER SYSTEM
FLOOR DRAIN
MECHANICAL FEES
GRADING
cu. yd.
$ plus x$
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FINAL INSP.
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
o
LAUNDRYTRAY
AIR HANDLING UNIT CFM
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET'
COMPRESSOR HP
POLE, TEM/PERM
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.
SQ. Fr. RESID ® 11/. c
SEWAGE DISPOSAL
SQ.FT.GAR ® VAc
HOUSE SEWER
MESH
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
o
REMARKS:
VENTILATION
FIRE ZONE ROOFING'
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESfINTfIALS
'
GARDEN WALL FINAL
1