BLCK (10040)P.O. BOX 1504 No. 10044
Building 53-33® ihIENDtJ2A 7&105 CALLE ESTADO
Address LA QUINTA, CALIFORNIA 92253
Owner
STEAFE GORDON
BUILDING: TYPE CONST.
A.P. Number
OCC: GRP.
Mailing
Address PALM D88HRT 73-415 PINYON
Cityr9-2260
ip
Tel.
PALM DESERT
568-67138
Legal Description
Project Description
RETAINING WALL 210' R 3'
Contractor
DON OSTER
Address
P 0 BOE 1481
CIANCHO MTRAGB
"P92270
1527-3023
State Lic.City"
& Classif. 2 77459 Lic. # ��
Arch., Engr., _
Sq. Ft.
Size
No. No. Dw.
Stories Units
Designer
New ❑ Add ❑
Alter ❑ Repair ❑ -Demolition ❑
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
70 OO) of Division 3 of the Business and Professions Code, and my license is in full force and
+' effect. fit^ "e�/ i
1
SIGNATURE L':;.� GT 4✓A ,/ 1 "" DATE
OWNER -BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Business and Professions Code: Any city or. county which requires a
permit to construct, atter, 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) o/
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 penally of not more than five hundred dollars ($500).
❑ 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
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 ownemployees,
provided that such improvements are not fntended or offered for sale. If, however, the building.
Estimated Valuation
$3150 '
PERMIT
' AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
-
Const.
Mech.
Electrical
;
or improvement is sold within one year o/ completion, the owner -builder will have the burden
of proving that he did not build or improve for the purpose o/ sale.)
Plumbing
'�
O 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.)
❑ I am exempt under Sec. B. 8 P.C. for this reason
S.M.I.
- •
Grading
Driveway Enc.
- Date Owner
Infrastructure
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent>tol'self-insure, or a•certificate of
Worker's Compensation Insurance, or a certified copy the�eof. (Sec. 3800, Labdr Code.)
Policy No. Company w f Y' a ." . J �,.
Q1 Copy is filed with the city. ❑ Certified copy is hereby furnished.
�,• co
�.�,r_^ r .,•, r, n f c°y z rit .,_�1 �_.t d 9 .
6."d> s c� ti i I ti
1 `_ 4 �[l j ' r 1" - 3' 4{)
r
TOTAL
Yr •
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
REMARKS
(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 person in any manner so as to become subject to the Workers' Compensation
_ Laws of California-
aliforniaDateOwner
Date-Owner
NOTICE TO APPLICANT. If, 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.
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
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.)
Side Street Setback from Center Line
Side Setback from Property Line
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.
FINAL DATE
INSPECTOR
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.
Issued by:
Validated by:
Date Permit
Signature of applicant Date -
ateMailing
Address -
Mail! ' ng
Validation:
r
City, State, Zip
CONSTRUCTION ESTIMATE
I STFL. SO. FT. ® $
2ND FL. SO. FT.
POR. SO. FT. ®
GAR. SO. FT. ®
CAR P. SO. FT.
WALL SO. FT. ®
SO FT ®
ESTIMATED CONSTRUCTION VALUATION $
NO. ELECTRICAL FEES
UNITS
MOBILEHOME SVC.
POWER OUTLET
NO. PLUMBING FEES -N-
EES1ST
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN.
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
SLAB GRADE
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
STORAGE TANK
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
ROUGH WIRING.
LAUNDRYTRAY
AIR HANDLING UNIT CFM
DUCT WORK
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 ® 1 Vi c
SEWAGE DISPOSAL
SO.FT.GAR ® 3hc
HOUSE SEWER
BOND BEAM
WATER SYSTEM
GAS PIPING
PERMIT FEE
PERMIT FEE:d
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
'9/Z / J
/
REMARKS.
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION -
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES11NITIALS
GARDEN WALL FINAL