003357 (BLCK)BuIlding t,
Address SMO A ��
Address P. 0. Box I
City Zip
ractor
ess
53-475 Beiraudas
P.O. BOX 1504 No. 003357
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
BUILDING.: TYPE CONST. OCC'. GRP.
A.P..Numbe,r 774-244-009 & 008 A,007
Legal Description
Project. Description Retainina wall.
-2501 at - 4-1 iiqh---
'City ... ... . .
Zip
Tel.'
La Qu i f
92253
564-0046
State Lic.
City
& Classif.
Lic. #
Sq. Ft.
Size
No. No. Dw.
Stories Units
....Arch., Enor..,.
Designer
New[3 Add 0
Alter 0, Repair 0 Demolition 0
Address
Tel.
City
Zip
State
I . .
Lic. #
LICENSED CONTRACTORS DECLARATION..
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of, the Buiiness and Professions Code, and my license is in full force and,
effect.
SIGNATURE %I DATE
OWNER -BUILDER DECLAWTION
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
requires the applicantJor such 'permit to rile a signed statement that he'is licensed pursuant to
Estimated Valuation
PERMIT
AMOUNT
the provisionsof the Contractor's License Law, Chapter ,9 (commencing with Section 7000) of
Division 3 of the Business and Professions Code, 6r.thal. �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 rive hundred dollars ($500).
CI 1,,as,owner of the property, or my employees. with wages as.theirsple compensation, will
Plan Chk. B61.
Const.
nA en
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
Mech.
builds or Irnpn6veslhereon'and who does such work himself or through his own employees,
provided that' such . improvements are not intended or offered. for sale: g, "however, the building
Electrical
or Improvementis 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.)
Plumbing
0 1, 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
does not apply to an owner of property who builds or Improves thereon, and who contracts for
S. M. 1.
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
0 1 am exempt under Sec. B. & P.C. for -this reason
Grading
Driveway Enc.
DateOwner
Infrastructure
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self-irisure, or a* certificate of
Worker's Compensation Insurance,or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy'No. Company pany
0 Copy is filed with the city. D.Certified copy is hereby furnished.
TOTAL
REMARKS
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 thp 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 It, after making this Certificate of Exemption you shouldbecome
subject to the Workers' Compensation provisions. of -the Labor Code, you must . forthwi th
comply with such provisions or this Permit shall be deemed revoked.
ZONE: BY: -
Minimum Setback Distances:
Front Setback from Center Lin
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY
Side Street Setback from Center Line
I 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
FINAL, DATE
-INSPECTOR-
Lender's Address
This is a building permit when properly filled out, signed and validated, and is subject to
expiration-it work thereunder is suspended for 180 days.
I certify. that I have read this application and state that Ilia 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 -of this city to enter the above-.
mentioned property for inspection purposes.
Issued by:
Validated by:
Date G10127 Permit
Signature of applicant Date -
Mailing .Address
Validation:
City, State, Zip.
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
2ND FL. SQ. FT.
POR. SQ: FT. ®
GAR. SQ, FT. ®
CAR P. SQ. 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
SLAB GRADE
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
ROUGH WIRING
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
DUCT WORK
LAUNDRY TRAY
AIR HANDLING UNIT CFM
GAS (ROUGH)
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
WATER HEATER
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
nn
BOND BEAM a/-�
SQ.FT.GAR ® 3/ac
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE IPL.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.
Z`,'REINF. STEEL-�L�—(�
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
nn
BOND BEAM a/-�
WATER SYSTEM
GRADING
cu. yd.
$ —Plus—X$—=$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
ML-- '
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 :d