9460 (BLCK)•' P.O. BOX 1504 No. 9460
_ "Building - 7&105 CALLE ESTADO '
Address E!S-72I SAN ISID1i0 LA QUINTA, CALIFORNIA 92253
Owner BLOCK
JOHN HAKAY NAIL
Mailing BUILDING: TYPE CONST. • OCC. GRP."
Address. SAME A.P. Number f
City Zip Tel.
LA QUINTA 92253 Legal Description
Contractor Project Description 69 X 105* BLOCK iWALL '
RICA PARZINSKY
Address
P 0 BOX 897
City] Zip TeL
R 226 327-8080
State Lic. City
&Classif. C-53- 72334 Lic.#- - 971 Sq. Ft. No. No.Dw.-. i
Arch., Engr., Size Stories -Units `
DesignerAB New p Add El Alter ❑ Repair 0 Demolition ❑
Address Tel.
City Zip State r !'
_ L'ic. #
LICENSED CONTRACTOR'S DECLARATION 4
-I hereby affirm that.I am licensed under provisions of Chapter 9 (commencing with Section
•" 7000) of Division 3/oI the Businessand Professions Coder,, and my Iicensg' i 'in full force and
•-e feet ,.�.l�.fi.>:'r•T �.+�.n r9.nria'�`9.c� h"
v S GNAT `�...•-'" X \ - 'DATE
�
OWNER•BUIL-p*R DECLARAT N Estimated Valuation
I hereby'affirm that I am exempt from the Contractor License Law for the following $2625.00
,%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 ... AMOUNT
+ requires the applicant for such permit to file a signed statement that .he Is licensed pursuant to, • PERMIT.
T_ the prosionvisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
for the alleged3 of exemption. Any violasiness and tion ons ofSectiothat.7031.5 b� exempt
applicant or a epermit Plan Chk. Dep. -
' subjects the applicant to a civil penalty of not more than rive hundred dollars (S500). .' >'�.3 C51 O
- r O I, as owner of the property, or my employees with wages as their sole compensation, will Plan Chk. Bal. s
do the work, and the structure Is not intended or offered for sale. (Sec. 7044, Sulsness and Const.
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.wfil have the burden Electrical`'
of proving that he did not build or Improve for the purpose of sale.) '���•
.-0 1, 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. .30 '
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
. O I am exempt under Sec. — B. 8 P.C. for this reason
Grading
Driveway Enc. ti -
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. 3900, Labor Code.)
Policy No, Company C . eft+- Tr� 'r 1t� J.
❑ Copy Is filed with the city.. ❑ Certified copy is hereby furnished. , '?i r w
TOTAL
CERTIFICATE OF EXEMPTION FROM REMARKS
WORKERS' COMPENSATION INSURANCE _
' (This section need not be completed.1f the permit is for one hundred .dollars (S 100) valuation +
or less.) r•`_. r --•� _
I certify that in the perfor.mance of thg work for which this permit is issued, I shall not
-employ any person in any; mariner so as to;be # me subject'to the Workers' Compensation
Laws f California. / /, '•
Date ~I fOwne�._'^Git
NOTIC TO APPOGFANT: If, after aking this Certificate ofi emptton you/should become ZONE: BY:
subject to the workers' Compensation provisions of the Labdr Code, y 'must forthwith MIRI1T1Ufn Setback Distances:
'comply with such provisions or this permit shall be deemed revoked. - -
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
Lenders 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'' 4Permit,
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-. a
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 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
r
YARD SPKLR SYSTEM
BAR SINK 4
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN.
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
A.C. UNIT
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
HEATING (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
DUCT WORK
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
GROUT
SO. FT. ® c
WATER HEATER
MAX HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
BOND BEAM
SO.FT.GAR ® 3/4c
HOUSE SEWER
GRADING
cu.yd
$ plus x$
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PLCK.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.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
rL
WATER SYSTEM
GRADING
cu.yd
$ plus x$
=$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
UP
I
REMARKS:
VENTILATION
FIRE ZONE ROOFING:
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING /
FINAL INSPECTION ///
CERT. OCC. V/
FENCE FINAL
INSPECTOR'S SIGNATURESfINITIALS
GARDEN WALL FINAL