10255 (BLCK)P O BOX 1504- N o 10255'
Building78-105 CALLE ESTADO .
Address ti '• $6'x%00 San IGidrO - LA QUINTA, CALIFORNIA 92253
Owner
Mr. am Mrs. shrackmortan
ld'
Mailing
BUILDING: TYPE CONST." OCC: GRP.
Address
A.P. Number.
City, +
Zip
Tel.
LaQuinti •
92253
Legal Description
Contractor
'Yom Stone 114iso Ei4
Project Description
Address
1141. Of 51
high garde-ri wall
P. O. Box 1333
City
Zip
Tel.:
_ LaQu3nta
92253
564--2128
State Lic.
City
& Classif. C29 494257
Lic. # 1228
Sq. Ft.
No. No. Dw.
Arch., Engr.,
Size...
.Stories Units
Designer
New ❑ . Add D.."
Alter ❑ Repair ❑ Demolitio'ri"❑
Address
Tel.
City
Zip
State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
11 hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of the Busines�s•land Professions Code, and my license is in full force and'
-" -•
'
,, 1SIGNATl1REDATE•
C..
= OWNER -BUILDER DECLARATION '
I hereby affirm that I am exempt from the Contractor's License Law for the following
Estimated Valuation
-
2,850
-•., 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 applicant for such permit to rile a signed statement that he Is. licensed pursuant to
_ .. PERMIT'
- •.
the provisions of the Contractor's License Law, Chapter9 (commencing with Section 7000) of
.AMOUNT
Division '3 ofthe BusinessandProfessions 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
Plan .Chk. Dep.
-
-subjects the applicant to a civil penally.of not more than rive 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
•
Const.
tj 4
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,
Mech:
'
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
Electrical `
of proving that he dad not build or improve for the purpose of sale.)
O 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 or property ,who builds or Improves thereon, and who contracts for
S.M.I. -
- .30 -
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
Grading
❑ I am exempt under Sec. B. 8 P.C. for 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. Company
i5� Copy is filed with the city: ❑ Certified copy is hereby furnished.
TOTAL
CERTIFICATE OF EXEMPTION FROM
WORKERS'COMPENSATIONINSURANCE
REMARKS
(This section need not be completed if the permit Is for one. hundred dollars ($100) valuation
or less.) ..
` _ _ ,_ ..,.
1 certify that in the performance of the work for which this permit is issued, Ishall not
d -} ,.
employ any person in any manner so as to become subject to the Workers' Compensation - .
Laws of California
Date Owner
NOTICE TO APPLICANT., ff. after making this Certificate of Exemption you should become
ZONE: •
' • BY:
subject to the Workers' Compensation provisions of the Laboi Code• you must forthwith
comply with such provisions or this permit shall be deemed revoked.
- - - -
M inimUm_ 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 read this application and state that the above information is correct.
Issued by:
Date Permit
1 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
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. 'PLUMBING FEES
1ST FL. SO. FT. ® $
2ND FL: SO. FT.
POR. SO. FT. ®
GAR. SO. FT. ®
CAR P. SO. FT.
WALL SO. FT. ®
SO 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
WASHER(AUTO)(DISH)
APPLIANCE DRYER
DUCT WORK
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
HEATING (FINAL)
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET'
COMPRESSOR HP
POLE, TEM/PERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER. B.T.U.
SO. FT. ® c
BATH TUB
BOND BEAM
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. 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 APPJEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
Ca« e Er T.4sP, (/7/111 D
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ata
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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 W INAL