003744 (BLCK)TWT 4 4 a".
P.O. BOX 1504 No.
Building 78-105 CALLE ESTADO
Address 53-125 Carranzat -LA QJUINTA, CALIFORNIA 92253
Owner
Mailing
Address 'Ramp -
City Zip Tel.
La Quinta 92253
Contractor
Cwher/Builder
Address . . . . i
City lZip
State Lic. City
& Classif. Lic. #
Arch., Engr.,
Designer
Address Tel.
City Zip State
. , I Lic. #
LICENSED CONTRACTOR'S DECLARATION
'I hereby affirm that I am licensed under Provisions of Chapter 9 (commencing with Section
7000)tof Division 3 of the Business and Professions Code, and my license is in full force and
effec .
SIGNATURE DATE
OWNERaBUILDER DECLARATION
I hereby affirm that I 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, after, 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 I-aw, Chapter 9 (commencing with Section 7000) of
Division 3 of the Business'and Professions. Code, or that. he is exempt therefrom, and the bast
for the alleged exemption. Any violation of Section 7031.5 by� 'any applicant for a permist
subjects the applicant to a civilpenalty ofnot more than five hundred dollars ($500).
0 1, as owner of the property, or my employees withfwages as their sole compensation, will
do the work, and the Structure is not intended or of ered for sale. (Se c*. 7044,. Buisness and
apply to an owner.of property who
Professions Code: The Contractor's License Law does not
builds or improves thereon and who does such work himself or through his own employees,
provided that such improvements 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 that he did not build or improve for the purpose of sale.)
0 1, as owner of the property, am exclusively contracting with licensed contractors to con-
struct Ahe 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 contractorts) licensed pursuant to the Contractor's License Law.)
0 .1 am exempt under Sec.—S. & P.C. for this reason
Date Owner
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. 3806, Labor Code.)
Policy No. Com pany
0 Copy is filed with the city. 0 Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars (S100) valuation
or less.)
I certify that in the performance of thp 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
of Cal fo ,
Laws i rnia.
Date =—Owner
NOTICE TO APPLICANT.- It, 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.
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 it work thereunder is suspended for 180 days.
I cer tify that I have read this application and state that the above information is correct.
I agree to comply with all city and c6unty 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
003744
BUILDING: TYPE CONST. OCC. GRP.'
A.P. Number
Legal Description
41 high by $01 retainirig
Project Description
wall
Sq. Ft. No. No. Dw.
-Size Stories Units. -
New [I Add 0 Alter 0 Repair 0 Demolition 0
Estimated Valuation
PERMIT
AMOUNT
P�lan*Chk.'Dep.
Plan Chk. Bat.
Const.
S25.00
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
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: Dat,.3/25189 Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING TtES
1ST 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
CARP. SO. FT. ®
GAS (ROUGH)
DRAINAGE PIPING
WALL SO. FT.
OTHER APP./EQUIP.
DRINKING FOUNTAIN
SO. FT. g
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, 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 ® 11/4 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
/
FOUND. REINF.� _l t�O
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP./EQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
?BONDBEAM L/'y�
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