BLCK (07203)T4 -ht 4 4 Q"
Building
Address
Mailing
Address p, d, Box 804
City Zip
Ira Quint& 92253
Contractor
Address
State Lic. I City
& Classif. Lic. ft
Arch., Engr.,
Designer
Address Tel.
City Sta
IZ'p I Licte
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
LICENSED CONTRACTORS 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
R
OWNER49JRDM DECLARATION
I hereby affirin that I am exempt from the Contractor's License Law for the following .
reason: (Sec. 7031.5,8rsiress and Professors Code: Any ray or courtly which requires a
permit to construct, ater, aprons, danafsh, or repai arty shucNe, prior to its issuance also
requires the appOcant for such perm to ®e a signed statement that he is licensed pursuant to
the provisions of the C inbadart License taw, Chapter 9 (carne nrig with Section 7000) of,
Division 3 of the Business and Rdessions Code, or that.he is exerno therefrom, and the basis
for the alleged exemption. Any violation of Section 7031.5 by 'ay applicant for a permit
subjects the applicant to a urn penalfy of not more than fire handed dollars (5500).
❑ 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, Busn"ess and
Professions Code: The Contractor's License Law does not apply to an owner of property who
builds or improves thereon and who dies such work himself or through Ins own employees.
provided that such irprovemats are not intended or offered for sale_ f, however, the building
Of improvement is sold wifhir ane year of compilation, the owner4rxTder WE have the burden
of proving that he did not build or irprove for the purpose of sale.) I``
❑ I, as owner of the property, am exclusively contracting with licensed contractors to cart=
struct the project (Sec. 7044, Business and Wdessiors Code: The Contractor's License Law
does not apply to an owner of rads property who bof irproves thereon, and who contracts for
such projects with a contra tors) licensed p rsrad to the Contractor's License Law.)
❑ 1 am exempt under Sec -----_____& & P -C_ for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
I hereby affirm that 1 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. CornPany
❑ Copy is filed with the city. ❑ Certified copy is hereby furnished.
CENnFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed 9 the pemT is for ane hundred dollars (S 100) valuation
or less.)
I certify that in the performance of tfrp wok for which this permit is issued, I shall not
employ any person in any mawrer so as to become subject to the Workers' Compensation
laws of Cali omia.
Date owner
NOTICE TO APPLICANT. f, after making this Cerbiicate of Exemption you should become
subject to the Workers' Co pensatim provisions of the Labor Code, you must forthwith
comply with such provisions or this penu't shelf be darned 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, CiwT Code_)
Lenders Name
Lender's Address
This is abuilding permit when property filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 100 days.
I certity that I have read this application and state that the above information is correct.
I agree to comply with all city and county or6nances and state laws relating to building
construction, and hereby arthorme representatives of this city to enter the above-
mentioned property for inspection purposes
Signature of applicant— Date
Mailing Address
City, state, Zip
No. 07203
NG: TYPE CONST. OCC: GRP.
P. Number. 774-223-007
(Legal Description
Project Description 2' X 1001' Retainiva troll
Sq. Ft. No. No. Dw.
Size Stories . Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
stimated Valuation
-
$11500
'� PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
j
Mech.
f
Electrical
Plumbing
_S:M.I.._
Grading
Driveway Enc.
Infrastructure
TOTAL
-ii--
REMARKS
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 2/23/90 Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
SLAB GRADE
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL. Sp. FT.
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. Sp. FT. ®
GAS (ROUGH)
METER LOOP
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
GAS (FINAL)
TEMP. POLE
DRAINAGE PIPING
CAR P. I SO. FT. ®
GROUT
WATER HEATER
WALL Sp. FT.
FINAL INSP.
DRINKING FOUNTAIN.
Sp FT ®
WATER SYSTEM
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTOXDISH)
APPLIANCE DRYER
FIRE ZONE ROOFING
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
GAR. FIREWALL
LAUNDRY TRAY
AIR HANDLING UNIT CFM
INSULATIONISOUND
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 V. c
SEWAGE DISPOSAL
SO.FT.GAR ® iLc
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 GOND. 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
ROCKSTORAGE
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
�t/Z 7/�O_,e
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
t