05349 (BLCK)4
P.O. BOX 1504 N o .
Building 78-105 CALLE ESTADO
Arlr1rPCC q'2—r%%An rADVA IMA LA QUINTA, CALIFORNIA 92253
COACMLA. Vr! UEY LMTD
BUILDING: TYPE CONST. OCC: GRP.;
Address 217 E. MOUZTZr 02
CityZip Tel.
PARI SPRINGS 92262 1 322-1020
Contractor
Address
State Lic. I City
& Classif. 387934 Lic. # 895
Arch., Engr.,
Designer
Address Tel.
CityI Zip I State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7(100) of Division 3 of the Business and Professions Code, and my license is in full force and
effect.
r
SIGNATURE DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5.8usiness and Professions Code: Any city or county which requires a
permitto construct, after, irpnove, demolish, or repair any structure, prior to its issuance also
requires the applicant for such permit to Me a signed statement that hes licensed pursuant to
the provisions of the contractor's Lice taw, 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
subjects the applicant to a civil penalty of not more than five Modred dofas (41500).
❑ I, as owner of the property, or my employees with wages as their sole compensation, will
do the work, andthe structure is not intended or offered for sale. (Sec. 7044, Suisness and
Prolessfons Code: The Contractor's License taw does not appty to an owner of property who
builds or inproves thereon and who does such work himself or through his own employees,
provided that such improvements are not intended or offered for safe. ff however, the building
orimprovement is sold withina one year of completion, the owner -builder will have the burden
of proving that he did not build or improve for the purpose of safe.)
❑ 1, as owner of the property, am exclusively contracting with licensed contractors to con-
struct the project. (sec. 7044, Bsihess and Professions Code: The Contractor's License Law
does not apply to an owner of property who builds or krproves thereon, and who contracts for
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec. R. 1i P.C_ for this reason
Date Owner
WORKERS COMPENSATION DECLARATION i
I hereby affirm that I have a certificate of consent.to seffiAsufe, or a certificate of
Workers Compensation Insurance, ora certified copy thereof, -(Se 3800, Labor Code.)
Policy No. Company
❑ Copy is filed with the city. ❑ Certified copy is hereby fumished.
CERTIFICATE OF EXEMPTION FROM
WORKERS'COMPENSATIONINSURANCE
(This section need not be completed ff the permit is for one hundred do0ars (41100) valuation
or less.)
I certify that in the performance of thg 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 APPUCANT: ft, after maluhg bets Certificate of Exemption you should become
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
Comply with such provtOOns or this pemrt 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, Cfvi Code.)
Lenders Name
Lenders Address
This is a building permit when property filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days.
1 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 mf this city to enter the above-
mentioned property for inspection purposes.
Signature of
Mailing Add
City, State,
Number 774--121-043
Description TAW 22 Riii 232 MIXT 19
Project Description RITAINING IWALL
05349
REMARKS y f
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 2/14/81 Permit
Validated
Validati
Sq. Ft. No.
Size Stories
No. Dw.
Units
New ❑ Add ❑ Alter ❑
Repair ❑ Demolition ❑
r
Estimated Valuation 2s250.
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
54.on
Mech.
Electrical
Plumbing
S.M.I.
.21
Grading
Driveway Enc.
Infrastructure
TOTAL
ff
REMARKS y f
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 2/14/81 Permit
Validated
Validati
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. ® $
UNITS
SLAB GRADE
2ND FL SQ. FT.
BONDING
YARD SPKLR SYSTEM
STORAGE TANK
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
DUCT WORK
ROCK STORAGE
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
HEATING (FINAL)
OTHER APPJEQUIP.
DRAINAGE PIPING
CAR P. I Sp. FT. ®
TEMP. POLE
WALL SQ. FT.
GROUT
DRINKING FOUNTAIN.
SQ FT ®
FINAL INSP.
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER SYSTEM
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
FINAL INSP.
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTONDISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
VENTILATION
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
GAR. FIREWALL
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID @ 1 Vi c
SEWAGE DISPOSAL
SQ.FT.GAR ® 1/ic
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 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 APPJEQUIP.
CREINF. STEEL G� .-
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
I