003442 (BLCK)Building
Address 54-770 Ramireg
Owner
.Ts�mRan T.a�i�i► �'»
Mailing
Address 53-475 Bermudas
City Zip
.-Lia 'Quirf,ta 92253
Contractor
'City lZip
State Lic.
& Classif.
Arch.,•Engr.,
Designer
44
P.O. BOX 1504 N 0.
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
Tel.
-564"'004
Tela
City
Lic. #
Address Tel.
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
r, I hereby affirm that I am licensed 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. t
SIGNATURE-"` -• .t tr+.. -'mss... . DATE
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
BUILDING: TYPE CONST. OCC: GRP
iA.P.,Number 774-30.1 '002
jLegal Description
Project Description 150' Retaininct Wail
Sq. Ft. No. No. Dw.
Size Stories Units'
New ❑. Add ❑ Alter ❑' Repair El Demolition ❑
Estimated Valuation
•�2 , 20.00
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 tliat.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 penafty,of not more than five hundred dollars ($500).
Plan Chk. Bal.
❑.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
Gorst.
Professions Code: The Contractor's License Law does not apply to an owner, of property who.
builds or improves thereon and who does such workhimself or through his own employees,
'.Mach.
. provided that such improvements are not intended or offered for sale. If, however, the building
or improvement is sold within one year or 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 con- .
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.L
F1
such projects -with a contractor(s) licensed pursuant to the Contractor's License Law.)
,,• „
Grading
❑ 1 am exempt under Sec. B. & P.C. (or 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.)
Policy No. ICompany
❑ Copy is filed with the city. ❑ Certified copy is hereby furnished.
TOTAL
CERTIFICATE OF EXEMPTION FROM
-REMARKS
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if. the permit is for one hundred dollars ($100) valuation
a Z.
q,\ j• l ?E 1 r?t.. +- r5' > 3�a-
or less.)
I certify that in the performance of thg work for which this permit is issued, I shall not •'
employ any peon in any manner so as to become subject to the Workers' Compensation
Laws of Cal ifornirsa.
' Date Owner
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 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
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
.
Lender's Address
FINAL DATE-
INSPECTOR
This is a buildi%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.
.• Issued by:
Date i h 1.n «7Permlt
I agree to comply with all city' and county ordinances and state laws relating to building
—T
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
HARD COPY
5_ r
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING i�EEC
1ST FL. SO. FT. ® $
2ND FL. SQ. FT.
POR. SO. FT. ®
GAR. SQ. FT. ®
CARP. 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
BONDING
FLOOR DRAIN
MECHANICAL FEES
FORMS
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APP./EQUIP.
LAUNDRYTRAY
AIR HANDLING UNIT CFM
gA!!fEMP. POLE/,—
_2�,
KITCHEN SINK
ABSORPTION SYSTEM. B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET'
COMPRESSOR HP
POLEJEM/PERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SO. FT. ® c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/a c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ac
HOUSE SEWER
REMARKS:
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
ROUND PLUMBINS=�
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./EQUIP.
REINF. STEEL
GAS (FINAL)
gA!!fEMP. POLE/,—
_2�,
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM l� ��
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
CERT. OCC.
FENCE FINAL
rL,I VM -J 01UNAI UMrWIMI I IALA,
GARDEN WALL FINAL