10516 (BLCK)P.O. BOX 1504
Ilding 51-566 RAMIR,EZ 78.105 CALLE ESTADO
dress LA QUINTA, CALIFORNIA 92253
nor
ADOLFO CAB.RERA
Ing
real SAME
CIt.LA QUINT4A 1Z9IP
2253
Contractor
OWNER BUILDER
Address
State Lie.I City
& Clasalf. Lie. 0
Arcn,, cngr.,
Designer
Address Tel,
I I Lie. q
LICENSED CONTRACTOR'S DECLARATION
I herebyY affirm that I em licensed under provisions of Chapter 9 (commencing'wlth Section
I'll
) of Dlvlelon 3 of the Business and Professions Code, and my license Is In full force and
effect.
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sao. 7031.8,8uelnass .and Professions Code: Any city or county which requires a
permit to construct, altar, Improve, . demolish, or repair an structure, prior to /Is Issuance also
requires the applicant for such permit to rile a signed statement. that he Is liceneod pursuant to
tha provisions of the Contractor's License Lew, Chapter 8 (commencing with Section 7000).of.
Dlvlslon.3 of the Business and Professions Code, or that,he Is exempt therefrom, and the basis
for the alleged exemption, Any violation of Section 7031.8 byy 'any aapppplicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollar® (5800),
0 1 as owner of the property, or my em loyees.with wages as their sole compensation, will
do.{he work and the structure is not Intended or offered for sale, (Sao. 7044, Sulsnoss and
Professions }rode: Tho Contractor's License Lew does not apply to an owner of property .who
bullda or Improves thereon and who does such work himself or through his own employees,
provided that such Improvements are not Intended or.offerad 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.)
G1 I, as owner of the propert , am exclusively contracting with licensed contractors to con•
struct the project. (Soo. 7044, Business and Professions Coda: 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 comtrector(s) licensed pursuant to tha Contractor's License Law,)
d 1 em exempt under Seo. B. & P.C. for thle reason
/Date a .r.'- ` - Owner%"1•A.��.✓S-1 �tA.�_._
k
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 certlfled copy thereof, (Sac, 3806,. Labor Coda.)
Polley No. Company
0 Copy Is filed with the city. 0 Certified copy -IG hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section mood not be completed If the permit le for one hundred dollars ($100) valuation
or less.)
I certify that In the performance of the work for which this permit Is Issued, I shell not
employ anyparson In any manner'so as to become subject to the Workers' Compensation
Laws of California, ,{
,Date ' "' 2 Owner
NOTICE TO APPLICANT: It, sfter rhaking, this Certificate of Exemption you Should become
subject to 'the Workers' Compensation provlslons of the Labor Coda, you must forthwith
comply with such provisions or this permit shall be doomed revoked.
CONSTRUCTION LENDING AGENCY
Ihereby affirm that there Is a construction lending agency for the performance of the
work for which this permit Is Issued, (Sao. 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 Iowa relating to building
construction, and hereby authorise representatives of this city to enter the above.:
mentioned property for Inspection purposes,
Signature of appllcant Date
Neill ng Address
City, State, 21p—
BUILDING: TYPE CONST,
A.P. Number
No. 10516
OCC: GRP,;
Legal Description
Project Description WOODEN FENCE 69 X 100 •
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:
Sq. Ft.
Size
No. No, Dw.
Stories Units
New ® Add 0
Alter 0 Repair C1 Demolition 0
Estimated Valuation
$850
PERMIT
AMOUNT
Plan.Chk, Dep, .
Plan Chk, Bal,
Const,
25 a r30
Mach,
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
$25.00
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: Date 'Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
SLAB GRADE
2ND FL. SQ. FT.
BONDING
YARD SPKLR SYSTEM
POR. SQ. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SQ. FT, ®
POWER OUTLET
ROOF DRAINS
CAR P. I SQ._ FT.
GAS (ROUGH)
DRAINAGE PIPING
WALL SQ. FT.
OTHER APPJEOUIP.
DRINKING FOUNTAIN.
SQ 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, TEMIPERM
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 ® 11/4 c
SEWAGE DISPOSAL
GAR. FIREWALL
SQ.FT.GAR @ Mc
HOUSE SEWER
LATHING
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 APPJEOUIP.
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 l t;
[[[
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATI ONISOUND
FINISH GRADING
FINAL INSPECTION -
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL