003726 (BLCK)P.O. BOX 1504 No. 003726
Building53-125 Carranxa 78-105 CALLE ESTADO
AddresLA QUINTA, CALIFORNIA 92253
Owner ..
E. B. Cirby
Mailing BUILDING: TYPE CONST. OCC: GRP.
Address Same?'74—X345-0J7
A.P. Number
City Zip Tel. ,
A Qurota 1 92253 1. Legal Description
Contractor Project Description 801 Of 61 high garden wall
owner Builder
Address .
City Zip Tela
State Lic. City
& Classif. Lic. # Sq. Ft. No. No. Dw.
Size Stories Units
Arch., Engr:,
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
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 Estimated Valuation
I hereby affirm that I am exempt from the Contractor's License Law for the following i♦�}
reason: ,(Sec. 703i.5,Business and Professions Code: Any city or county which requires a
permit to construct, atter, improve, and,
or repair any structure, prior to its issuance also - AMOUNT
.requires the applicant for such permit to rile a signed statement that he is licensed pursuant to -PERMIT
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 Plan Chk. Dep.-
subjects
ep.subjects 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 _ Plan Chk. Bal.
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and CiOfISt.? fl
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, M@CII. '
provided that such. improvements are not intended or offered for sale. If, however, the building
orimprovement is sold within one year of completion, the owner -builder will have the burden Electrical '
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- Plumbing
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 S.M.I.
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
111 am exempt under Sec. B. & P.C. for this reason Grading
Driveway Enc.
r Yf. ��
Date /, + '� Owner _t f �""A_ -r �� f; Infrastructure
WORKERS' COMPENSATION DECLARATION
I hereby affirm th8t 'l 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.
TOTAL
CERTIFICATE OF EXEMPTION FROM REMARKS
WORKERS'COMPENSATIONINSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100) valuation
or lessf)
I certify that in the performance of tha 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: If, alter making this Certificate of Exemption you should become _ ZONE: BY:
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith Minimum Setback Distances -
CONSTRUCTION
with such provisions or this permit shall be deemed revoked.
Fo tS tb kf C
CONSTRUCTION LENDING AGENCY
Ihereby 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 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
HARD COPY
>r`
I n e ac rom enter Llne
Rear Setback from Rear Prop. Line
Side Street Setback from.Center Line
Side Setback from Property Line
FINAL DATE_ INSPECTOR
Issued.by: DateJ�l Permit
Validated by:
Validation:
AL
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBINGIFEES •
IST FL. SO. FT. @ $
UNITS
SLAB GRADE
2ND FL. SO. FT.
BONDING
YARD SPKLR SYSTEM
POR. SO. FT. @
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. @
POWER OUTLET
ROOF DRAINS
CAR P. SO. FT. @
GAS (ROUGH)
DRAINAGE PIPING
WALL SO. FT. @
OTHER APPJEQUIP.
DRINKING FOUNTAIN
SO. FT. @
TEMP. POLE
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GROUT
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SYSTEM
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FINAL INSP.
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, TEM/PERM
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
GAR. FIREWALL
SO.FT.GAR @ 3/ac
HOUSE SEWER
LATHING
GAS PIPING
PERMIT FEE
MESH
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
ZVFOUND. REINF. - ?/� fY
.!
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
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
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
'
INSPECTOR'S SIGNATURESIINITIALS,
GARDEN WALL FINAL