15122 (BLCK)Building 53-800 Ozark ez
___ Lillian Pendleton
Mailing
Address 53-800 Ramirez
city �� Zip 52253 Tel.
Quinta
Contractor
Tom Stone Masonry
tt
P.O. BOX 1504
78-495 CALLE TAMPICO
LA OUINTA, CALIFORNIA 92253
Address'... .
P.O. Box 1333
City. baa Qs`l, inter Zip 92253 1Tel.: 564-2428
State Lic. City
8 Classic. 494257 , C-29 Lic. # 1228
Arch., Engr.,
-Designer
Address Tel.
City]Zip State
Lic. #
LICENSE )bONTRACTOWS DECLARATION
I hereby affirm that I am lie sed under provisions of Chapter.9 (commencing with Section
7000) of Division 3 of the Business and Professions Code, and my license is in full force and
effect.r,,..];,,,— �+✓
OWNER -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, 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 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 civilpenally of not more than rive hundred.dollars ($500).
O 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 bulld or improve for the purpose of sale.)
❑ I, as owner of the property, am exclusively.contracting with licensed contractors to con-
struct the project. (Sec. 7044, Businessand.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 contractor(s) licensed pursuant to the' Contractor's License Law.),
❑ 1 am exempt under Sec B. & 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 certified copy thereof. (Sec. 3800, Labor Code.)
Policy,No. Company
--O Copy is filed with the city. ❑ 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 ($100) valuation
or less.)
I certify that in the performance of the 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 APPLICANT: ft, alter 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.
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND
SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES ANO.CIVIL FINES UP TO ONE
HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION,
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND'
ATTORNEY'S FEES.
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.
I car ify,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 authorizerepresentatives of this- city to enter the above-.
mentioned property for inspectionmpurposes.
Signature of applicant Date
Mailing Address
City, State, Zip
No. 15122
BUILDING: TYPE CONST. . OCC: GRP.
P. Number
gal Description
oject Description 15' @ 6' Gardenwall
REMARKS
ZONE: ' BY:
Minimum Setback Distances:
Front Setback from Cr/ �ine
Rear Setback fro ar Prop. Le'
Side Street Setb,pck from0Center Lin
Side Setback frorl�v,,Property L/i�e
FINAL DA
Issued by
Validated
Validatior
Sq. Ft.
Size
No.
Stories
No. Dw.
Units -
New ❑ Add ❑
Alter ❑
Repair ❑ -Demolition ❑
Estimated: Valuation -
$8i5.06
PERMIT.
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
*Z:11. UU
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
; d_-1 U U
REMARKS
ZONE: ' BY:
Minimum Setback Distances:
Front Setback from Cr/ �ine
Rear Setback fro ar Prop. Le'
Side Street Setb,pck from0Center Lin
Side Setback frorl�v,,Property L/i�e
FINAL DA
Issued by
Validated
Validatior
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBINU FEES'l
1ST FL. SO. FT. ® $
UNITS
SLAB GRADE
ROUGH PLUMB.
BONDING w
YARD SPKLR SYSTEM
2ND FL. SO. FT.
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
GAS (ROUGH)
METER LOOP
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
GAS (FINAL)
TEMP. POLE
DRAINAGE PIPING
CAR P. S0. FT.
GROUT
WATER HEATER
WALL SO. FT.
FINAL INSP.
DRINKING FOUNTAIN.
SO. FT. ®
WATER SYSTEM
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
FIRE ZONE ROOFING
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
LATHING
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
FINISH GRADING
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 w
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./EQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM S�(�
WATER SYSTEM
GRADING
cu. yd.
$ -Plus-X$-=$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
C
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