003645 (BLCK)P.O. BOX 1504 NQ.. 003645
Building 78-105 CALLE ESTADO
Address 54-865 Avenida Ramirez LA QUINTA, CALIFORNIA 92253
Owner
AICD aDeVell5''Merla» BUILDING: TYPE CONST. OCC: GRP.
Mailing
Address 69-730 blichwasi 311, 4118--, w - _. A:P.,Number _ - .. 774295- 018
City Zip
Legal Description
Contractor Project Description 100# X 3' . Retain' 311a Wall
..Address aftd 88of 2 e PrtC?t?lfninct {dal,$•
city
y .. _ .. :. Zip Tela .
State Lic. v City
& Classif.. Lic. # 1038 Sq. Ft. No. No. Dw.
Arch:, Engr.;... .... -- - - . _
Size ' Stories' Units
Designer New ❑ Add ❑ • Alter ❑ Repair ❑ Demolition.p.
Address Tel.
City Zip State
-05 Lic. #
LICENSED CONTRACTOR'S DECLARATION.
I hereby affirm that cram licensed under provisions of Chapter 9 (commencing with Section
7000) of Division,3'ofrthe Business and Professions Code, and my license is in full force and
effect...
SIGNDATE _
` OWNER -BUILDER DECLARATION ' EStlmated ValUatlOn
I hereby affirm that I am exempt from the Contractor's License Law for the followingq�n '
• reason: .(sec. 7031.5,Business and Professions Code: Any city or county,. which requires'a;
permit to construct, alter, I improve, demolish, or repair, any structure, prior to its issuance also - - - r -
requires the applicant for such permit to file a signed statement:that he is licensed pursuant to PERMIT ' - AMOUNT
the provisions of the Contractor's License Law; Chapter9 (commencing with .Section 7000) of. -
- Division 3 of the Business'and Professions Code, or thah he is'-exerrrpt 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): ' - '
- c, , as owner of the property, or my employees with wages as their sole compensation, will. Plan Chk. Bal.
• tlo the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and Const.
Protessions Code: The Contractor's License, Law does not: apply to an owner of property who - - V'=25-.00.
'buildsor improves thereon and who does such. work himself through his own employees, -
provided.that'such improvements: are not Intended or,offered for sale..If, however,. the building. Mcch.-
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 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.I. �, 50
such projects with -a contractor(s) license&pursuant to the Contractor's License Law.)
El am exempt. under Sec. B. & P.C.- for, this.reason.
Gfading
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. Company
O 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 _ _
. , or less.) . .. t� 3 er1 �/ rFr'. t ... iJC j -
si
I certify that in the performance of the work for which this permit is issued, I shall not is
employ any person in any manner so as to become subject to the Workers' Compensation
Laws of California.
ate Owner
NOTICE TO APPLICANT: If, alter making this Certificate of Exemption you *Should become
-'Workers'
ZONE:'
BY:
subject to the 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' 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 this
y.,qf
i /-8
read application and state that the"above information is correct.
Issued by:
Date +{ Permit
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
HARD COPY
.
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES'
1ST FL. SO. FT. ® $
2ND FL. SQ. FT.
POR. SO. FT. ®
GAR. SQ. FT. ®
CAR P. I 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
FLOOR DRAIN
MECHANICAL FEES
HEATING (ROUGH)
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(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,TEMIPERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SO. FT. ® c
BATH TUB
r -
BOND BEAM
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
LUMBER GR.
SO.FT.GAR ® 3/ac
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 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 APP.IEQUIP.
REI F. STEEL Z
®g
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
r -
BOND BEAM
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
INSPECTOR'S SIGNATURESIINITIALS,
GARDEN WALL FINAL
71