04846 (BLCK)04846
• P.O. BOX 1504
Building78-105 CALLE ESTADO
Address ?�..aTt �Itlfi��'C"O LA QUINTA, CALIFORNIA 92253_
Owner
George Jacobson
Mailing
Address 78-230 Salo
City Izip
Contractor
pelt Construction
-- --, 64-060 'trobile Dr.
BUILDING: TYPE CONST OCC. GRP. ,
A.P. Number TA C413 nta Caolf '�',AtA't on
el.
Legal Description
Project Description 55' X 61 blacks wall
City ZipTel.
Denett, riot Sprti a. 9224 3 .321§46965 .
State Lic. City
& Classif. 317631 Lic. #
Designer
Address Tel.
CityI Zip I State I
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions ofrChapter 9 (commencing with Section
70 OO) of Division 3 of the Business and Professions Code and my license isfin full force and
effect jt 'f a 'r y
�� . J :..,• t t�,-,.A Cad /r
SIGNATURE - '" �'' '�` iS' DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractors License Law for the following
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 file a signed statement that he is licensed 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 five hundred dollars ($500).
❑ 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
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 sale.). -
0 I, as owner of the property, am exclusively contracting with licensed contractors to con-
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
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
❑ 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 certifiedtcopy,thereotff (Sec. 3800, Labor Code.)
Policy No. Company F.e.1,
O Copy is filed with the city. O Certified copy is hereby fur shed.
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 thg work for which this permit is issued, I shall not
employ any person in any manner so as to become subject to the Workers' Compensation
Laws of California.
Date -Ow ner
NOTICE TO APPLICANT., It, after making this Certificate 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.
REMARKS '-
ZONE: BY:
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 Lin_ e
Lender's Name -
-Lender's Address
This is a building permit when properly filled out, signed and validated, and is subject to FINAL DATE I4qN9qSPEttCTJOR��yy `
expiration it work thereunder is suspended for 180 days.
Icertify that' have read this application and state that the above information is correct. Issued by: • Date Permit
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. ,k Validated by: -
Signature of applicant
Mailing Address t Validation: • ^' • `
City, State, Zip ,
t4 7� 9
WHITE - FINANCE PINK APPLICANT, GREEN = BUILDING, GOLDENROD,- ASSESSORS OFFICE HARD COPY - FILE
_,. �_ v.... '.�:: v.. .., .. `.JL ..._ ,.• .. 1',. .. �_"S ?. .. ..r _.t .. r3' "T.w�r+\.. .,+..r„a-. ... ... ., �•.. ... a,..�.i,. i._._te. ,_ kr .,,.. t�..., .. ... S'..:.T.._::.... __ ”, ,- ➢, .,.5 �.. ..: i.
Sq. Ft.
Size
No.
Stories
No. Dw.
Units
New ❑ Add ❑
Alter ❑
Repair ❑ Demolition ❑
Estimated Valuation
$1,350
PERMIT
AMOUNT
Plan Chk. Dep.
$14.30
Plan Chk. Bal.
-
Const.
7
2.d s 00
Mech.
Electrical
Plumbing r
S.M.I.
.50
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS '-
ZONE: BY:
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 Lin_ e
Lender's Name -
-Lender's Address
This is a building permit when properly filled out, signed and validated, and is subject to FINAL DATE I4qN9qSPEttCTJOR��yy `
expiration it work thereunder is suspended for 180 days.
Icertify that' have read this application and state that the above information is correct. Issued by: • Date Permit
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. ,k Validated by: -
Signature of applicant
Mailing Address t Validation: • ^' • `
City, State, Zip ,
t4 7� 9
WHITE - FINANCE PINK APPLICANT, GREEN = BUILDING, GOLDENROD,- ASSESSORS OFFICE HARD COPY - FILE
_,. �_ v.... '.�:: v.. .., .. `.JL ..._ ,.• .. 1',. .. �_"S ?. .. ..r _.t .. r3' "T.w�r+\.. .,+..r„a-. ... ... ., �•.. ... a,..�.i,. i._._te. ,_ kr .,,.. t�..., .. ... S'..:.T.._::.... __ ”, ,- ➢, .,.5 �.. ..: i.
N:
CONSTRUCTION ESTIMATL
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL SO Fl y S
UNITS
SLAB GRADE
ROUGH PLUMB
i
YARD SPKLR SYSTEM
2ND FL SO F1. a
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR SO FT at
GAS (ROUGH)
METER LOOP
GAR SO. FT. @
POWER OUTLET
ROOF DRAINS
GAS (FINAL)
TEMP. POLE
DRAINAGE PIPING
CAR P. SO FT. a
GROUT
WATER HEATER
WALL SO. FT. Q
FINAL INSP.
DRINKING FOUNTAIN
SO. FT. fB
WATER SYSTEM
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTONDISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
FIRE ZONE ROOFING
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
LATHING
SO. FT. @ c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID 1V: c
SEWAGE DISPOSAL
SO.FT.GAR >r:c
HOUSE SEWER
FINISH GRADING
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 8 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.IEOUIP.
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
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 WALL FINAL