11428 (BLCK)Tit!t
4
4a
P.O. BOX 1504 No. 11428
Building 78-105 CALLE ESTADO t
Address 52--380 Ttm.irez LA QUINTA, CALIFORNIA 92253ILI
t
Owner
Tom & Susan Toles
Mailing BUILDING: TYPE CONST. OCC: GRP. -
Address 48-100 Beverly Drive
A.P. Number
City Zip Tel.
P. D. 92260 346-7767 Legal Description
Contractor Project Description
Fort Toles- 100' .
of 5' block: wall
Address
Same
'City Zip Tel.:
State Lic-, City
& Classif. B 359948 Lic. # Sq. Ft. No. No. Dw.
Arch., Engr., Size Stories Units
Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address Tel.
City fr.�= Zip State
i Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirT�that I am licensed underpprovisions,of Chapter 9 (commencing with Section n
7000) of Division 3 of the Business and"Professions Code/, olid my license is in full force and , . " '•
effect"",�'�r"
1GNATURE', DATE c
OWNER -BUILDER DECLARATION Estimated Valuation
I hereby affirm that I am exempt from the Contractor's License Law for the following S
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
requires the applicant for such.permit to rile a signed statement,that he is licensed pursuant to - PERMIT AMOUNT
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 the applicant to a civil penalty of not more than five hundred dollars ($500).
❑ 1, 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, Sulmess and Const. 54.00 -
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, Mech.
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' 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 coo-, 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. .30
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) -
Grading
❑ 1 am exempt under Sec. B. & P.C. for this reason
Driveway Enc. ,
Date owner Infrastructure
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. 3800, Labor Code.)
Pdlicy No. Company
.O Copy is filed with the city. Cl Certified copy is hereby furnished. r`
TOTAL 54.30
CERTIFICATE OF EXEMPTION FROM REMARKS
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permitlis for one hundred dollars ($100) valuation.h ;i"a{{^„_r _?'<_(� n•x,r y}_ ,f?A.. ti{,_,{�n �.�!
or less.) ?. ! .t.
I certify that in the performance off hp work for which this permit is issued; I";shall not
employany person in any manner so'as.to"tiecome'subject to therWorkers"'Compensation
Laws of California
Date wner f` '-..s'/7r�`"-�,`.�Sfs�".•.:r //,f/ ,�s-'
NOTICE TO APPLICANT: If, 'after -making this Certificate of -Exemption you should become ZONE: BY:
subject to the Workers' Compensation provisions of the Labor Code, you must forthwithMinimum Setback Distances:
comply with such provisions or this permit shall be deemed revoked. t
Front. Setback from Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY Side Street Setback from Center Line
1 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.) Side Setback from Property Line
Lender's Name
Lender's Address
This is a building permit when properly filled out, signed and validated, and is subject to FINAL DATE INSPECTOR
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 Issued by: Date Permit
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. Validated by:
Signature of applicant— Date
Mailing Address Validation:
City, State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
2ND FL. SO. FT.
FOR. SQ, FT. ®
GAR. SO. FT. ®
CAR P. SO. FT.
WALL SQ. FT. ®
SQ. FT. ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN.
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
HEATING (ROUGH)
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
DUCT WORK
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
HEATING (FINAL)
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
BOND BEAM 3v CJ
6G
SQ. FT. ®c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 1+/4 c
SEWAGE DISPOSAL
LUMBER GR.
SQ.FT.GAR ® V4c
HOUSE SEWER
FRAMING
FINAL INSP.
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE TLUMB. FEE
STRUCTURE I 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. 4
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM 3v CJ
6G
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- 3
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESJINITIALS
GARDEN WALL FINAL