9908 (BLCK)2 P" irding
address
`7 - -7 (D 60,11 pyl &---I P.O. BOX 1504
78-105 CALLE ESTADO
5 3 LA QUINTA, CALIFORNIA 92253
BILL STONE
Mailing
Address 38152 ROCK CIR
City Zip Tel.
PALM DESERT 92260.
Contractor .
OWNER BUILDER
Address
SAME
City Izip I Tel.:
'Mate tic.-- City
& Classif. Lic. #
Arch., Engr.,
.Designer
Address Tel.
City Zip State
I I Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7�W' of Division 3 of the Business and Professions Code, and my license is in full force and
ffect
SIGNATURE DATE
OWNER -BUILDER DECLARATION
I hereby affimii 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-ficensed 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 civil penalty of not more than rive hundred dollars,($500).
0 1; 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 build or improve for the purpose of safe.)
�1, as owner of the property, am exclusively cbritracting with licensed contractors td.-cdrv-
a ruct
'tl the project. (Sec. 7044, Business and Professions Code: The Contia6tor 's LicenselLiw
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.)
0 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 a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. ompany
0 Copy is filed with the city. 0 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 thp work for which this permit is issued, I shall not
employ any person in any manner, so as to be.cdme su6jecVto the Workers' Compensation,
Laws of California.
Date -Owner
NOTICE TO APPLICANT. It, aft&-makini- this -Certificatd' 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.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 309 7, Civil Code.)
Lender's Nam
Lender's Address
This is a buildin� permit when properly filled out, signed and validated, and is subject to
expiration it work I ereunder is suspended for 180 days.
I car tity 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 authorize representatives -of this city to enter the -above-.
mentioned property for inspection purposes.
Signature of applicant� -Date.
Maili ' ng Address
City, State, Zip
No.
U
BUILDING: TYPE CONST. WALL OCC'. . GRP.
A.P. Number
Legal Description
I RETAINING AND GARDEN WALL
Project Description
3' X 50'
Sq. Ft. No. No. Dw.
Size Stories —Units
New 0 Add 0 Alter 0 Repair 0 -Demolhion 0
Estimated Valuation
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
$16.25
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS
x -ft " -e� "�l
k_6 , 3 5
ZONE:- BY:
Minimum Setback Distances:
Front Setback from Center Lin
—Rear Setback from Rear Prop. Line
SideStreet Setback from Center Line
Side Setback from Property Line
FINAL DATE __,__INSPECTOR
Issued by: —Date_Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
I ST FL. SQ. FT. @ $
�UNITS
COLL. AREA
2ND FL SQ. FT. @
ROUGH PLUMB.
YARD SPKLR SYSTEM
POR. SO. FT. 0
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. @
POWER OUTLET
ROOF DRAINS
CAR P. 0. FT.@
DUCT WORK
DRAINAGE PIPING
WALL SO. Fr. @
GAS(ROUGH)
DRINKING FOUNTAIN.
SQ. FT. @
HEATING (FINAL)
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GAS (FINAL)
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER HEATER
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
WATER SYSTEM
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
GRADING
cu. yd.
$ -plus_x$
LAUNDRYTRAY
AIR HANDLING UNIT CFM
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET
COMPRESSOR HP
POLE, TEM/PERM
LAVATOR
HEATING SYST9M- FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER. B.T.U.
SO. FT. @ c
BATH TUB
SQ. FT. @ c
WATER HEATER
MAX HEATER OUTPUT, B.T.U.
SO. FT. RESID @ 1 V4 c
SEWAGE DISPOSAL
SQ.FT.GAR @ 3/4c
HOUSE SEWER
SPARK ARRESTOR
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBIL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE ELECT.FEE
SMIFEE 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
ROCKSTORAGE
FOUND. REINF.
GAS(ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
GAS (FINAL)
TEMP.. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ -plus_x$
LUMBER GFI.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING:
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION -
CERT. OCC.
FENCE FINAL
INSPECTOR'SSIGNATURES11NITIALS.
GARDEN WALL FINAL