BLCK (11108)Building 54'355 MendozaArlrlrocc
Owner
Samuel Fitton
P.O. BOX 1504 `' 140.
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
.•y
P. 0. Box 415
Address
CityZip Tel.
La Quinta 92253 .564-3005
Contractor
owner/Builder
Address
Tel.:
State Lic. City
& Classif. Lic. #
Arch., Engr.,
Designer
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
7000) t.of Division 3 of the Business and Professions Code, and my license is in full force and
• effec
SIGNATURE DATE
OWNER -BUILDER DECLARATION -
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Busfeess 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 rile a signed statement'that he is licensed pursuant to
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) or
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
sLLubjects the applicant to a civil penalty of not more than rive 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 'reproves thereon and who does such work himself or through 'his own employees,
provided that such improvements are not intended or offered for sale. ff. however, the building
or improvement is sold within one year of completion, the owner -builder wig have the burden
of proving that he did not build or improve for the purpose of sale.) - -
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-
struct the project (Sec. 7044, BusinessandProfessions 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 contractors) licensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec B. & P.C. for this reason
Date Own �. i�''v r' r•�C�
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. O Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS'COMPENSATIONINSURANCE
(This section need not be completed ff the permit is for one hundred dollars (5100) valuation
or less.) -
I certify that in the performance of: the work for which this permit is issued, I shall not
=any person in any banner so as to become subject to,the Workers' Compensation
Laws of Catifomia
DateOwr�r
NOTICE TO APPUCANT g, after making this Certificate of Exemption you should become
subject to the Worker' 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 if work thereunder is suspended for 180 days.
I certity 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 authorize representatives of this city to enter the above-.,
mentioned property for inspection purposes.
Signature of applicant Date
Mailing Address
City, State, Zip
11108
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number.
Legal Description
Project Description
5t of 514" block wall
Sq. Ft.
Size
No. No. Dw.
Stories Units
New ❑ Add ❑
Alter ❑ Repair ❑ -Demolition ❑
Estimated Valuation
1,840.25
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
45.00
Mech.
Electrical
t
Plumbing
S.M.I.
.20
Grading
Driveway Enc.
Infrastructure
TOTAL
45.20
REMARKS
`
JJyy (t�p `` �C. j L [I� jn�
.01 1G/. .r)-i•f A-Jfl �',."I'l-Q6 i2G7"�7ie1. g- e'v!� tV
.
Mi✓ vl"1MGG JY Gtt .1'04. s u_ -�.+
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 -Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. ® $
2ND FL. SO. FT.
POR. SO. FT. ®
GAR. Sp, FT. ®
CAR P. SO. FT.
WALL SO. FT. ®
Sp FT ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOB]LEHOME 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
I
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APPJEOUIP.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
TEMP. POLE
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET'
COMPRESSOR kp
POLE, TEM/PERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER. B.T.U.
SO. FT. ®c
1BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® I+/. c
SEWAGE DISPOSAL
SO.FT.GAR ® VAc
HOUSE SEWER
REMARKS:
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 Q117
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
I
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 X
WATER SYSTEM
GRADING
cu. yd.
$ 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 SIGNATURESIINITIALS
GARDEN WALL FINAL