15665 (BLCK)Builin
Address 46-800 Highlan
Owner
David M. Cosper
Mailing
Address 46-800 Highland
CityZip
,3atita �� 92253
Contractor Owner Builder
Address
p
_ -Statb Lic.
& Classif.
Arch., Engr.,
Designer
Address
4
P.O. BOX 1504
78-495 CALLE TAMPICO
Palm Dr. LA QUINTA, CALIFORNIA.92253 "
palms Fir.
Tel.
Tel.
LDING: TYPE CONST
Number
No. 15665
OCC: GRP.:
Legal Description
Project Description 50 t 51 Re raining wall
# Sq. Ft. 5(). if No. No. Dw.
Size Stories Units -
City Zip State
Oma' ___ - Lic. #
1 LICENSED CONTRACTOR'S DECLARATIO,
I hereby affirrtha Ilam lirsed under provisions of Chapter 9 (commencing with Section
X»� of Division 3;pflhe•Bjfstness'and�Professions Code, and my license is in full force and
New ❑ Add ❑ Alter ❑ Repair ❑
Demolition ❑
1
lk_ _>a d Ar I1
REMARKS
SIGNATURE rW DATE
WNE -BUILDER 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, alter, Improve, demolish, or repair any structure, prior to its issuance also
Estimated Valuation
$1,200.00
`
-
O
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) 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 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 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.)
PERMITAMOUNT
- -
NOTICE TO APPLICANT. ANIf, after making this Certificate of Exemption you should become
'
Plan Chk. Dep.
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
Plan Chk. •Bal.
Const.. 4,
•
Mech.
.
- `
Electrical
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES -LIP TO ONE
Plumbing
HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION,.
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-
struct the project. (Sec. 7044, Business and .Professions Code: The Contractor's License Law
S.M.I. -
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vL '9` ` V�
does not apply to an owner or property builds or improves thereon, and who contracts for
such projects with a contractor(s) b sed puns t to the Contractor's License Law.)
O 1 am exempt u der Sec. C. this reason
/ Q J.. _
Grading
T his is a buildingFINAL
permit when properly filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days.
Driveway Enc.
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
L�
DateT+ Owner
Infrastructure
1
WORKERS' COMPENSATION DECLARATION
Validated by: - //7/
Signature of applicant Date
.Mailing Address
I hereby affirm that I have a certificate of consent to self -insure, or a certificate of
City, State, Zip
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. Company
❑ Copy is filed with the city, 0 Certified copy is hereby furnished.
TOTAL'
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
REMARKS
(This section need not fie completed if the permit is for one hundred dollars IS 100) valuation
'
' or less.)
I certify that in the performance of the work for which this permit is issued, I shall not
-employ-anyparson in any manner so as to become subject'to the Workers' Compensation
Laws of California
O
NOTICE TO APPLICANT. ANIf, after making this Certificate of Exemption you should become
'
ZONE: BY:
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
Minimum Setback Distances: -
Front Setback from,Center Line
-�
Rear Setback from Rear Prop. Line
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, ANDl
�_6 ";KSHALL
Side Street Setback from Center Line
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES -LIP TO ONE
from�Property U ne�
HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION,.
Side Setback - '
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND •
ATTORNEY'S FEES.
�j �y /- -
vL '9` ` V�
DATE INSPECTOR
T his is a buildingFINAL
permit when properly 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
Issued by: Date _'Permit
Al
W,
construction, dherebyauthorize r presentatives .of this city to enter the above-.
1
mentioned property for inspection purposes.
Validated by: - //7/
Signature of applicant Date
.Mailing Address
Validation:
City, State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
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
CAR P. I SO. FT.
GAS (ROUGH)
DRAINAGE PIPING
WALL SO. FT.
OTHER APP./EOUIP.
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.
SO. FT. ®c
BATH TUB
SPARK ARRESTOR
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ac
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE JELECT.FEE
SMI FEE 1771
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 APP./EOUIP.
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
O
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION 3 i9 96
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL