12812 (BLCK)P.O. BOX 1504 No, 12812
Building 78-105 CALLE ESTADO
Address 48~885 Ave. El Nbdo LA QUINTA, CALIFORNIA 92253
Owner Hs. Nola Dyal
Mailing BUILDING: TYPE CONST. OCC: GRP.
Address Smug
A.P. Number
City ZipTel.
La Quin,'Cat t 92253 Legal Description
CO:iaotoluCSa1�.Y►S �OiSt�Cf�Yl Project Description 4Q1 f3 5= high block wall
Ad9rgsspinyon Cry at
I C*it'' Zip Tela
M . center,- A 92561 349--3327
State Lic. �� City
& Classif. Lic. # Sq. Ft. No. No. Dw.
Arch., Engr.; Size Stories Units
Designer New ❑ • Add ❑ Alter ❑ Repair ❑ 'Demolition ❑
Address Tel.
i
I .
City, , Zip State
"r Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm'that I am licensed under provisions of Chapter 9 (commencing with Section
00) of Divisionynyy3 of the Business nd Professions Code, and my license is in full force and,
effect. + i"�j./iv'.�r .i:+�-^.-.^�..-�,+.. -..•,' ,'"�' `X
StGNATURE .0 ^..-•"T` DATE'
ti
OWNER -BUILDER DECLARATION Estimated Valuation ��� 0�
I hereby affirm 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, 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 PERMIT - AMOUNT
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) o/
Division 3 of the Business and Professions Code, or that. he is exempt therefrom, and the basis -
for the alleged exemption. Any violation o/ 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).
O 1, as owner of the property, or my employees with wages as their sole compensation, will Plan Chk. Bal. -
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and Const.Professions Code: The Contractor's License Law does not apply to an owner of property who 25. 00
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 thelburden Electrical
of proving that he did not build or improve for the purpose or 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 of property who builds or improves thereon, and who contracts for S. M. 1.
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
Grading
O 1 am exempt under Sec. B. & 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
O Copy is filed with the city. O Certified copy is hereby furnished.
TOTAL l • U
CERTIFICATE OF EXEMPTION FROM j3.EMAR_K_S
WORKERS' COMPENSATION INSURANCE ` — •` ' •3 °`'t a^ " moi' ^ a
- w srw �e wva.
(This section need not be completed it the permit is for one hundred dollars ($100) valuation _
or less.)
I certify that in the performance of the 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
ws of California+;'
Owner
NOTICE TO APPLICANT: If, after making this' Certificate 6f7 Exemption you should become ZONE: • BY:
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith Minimum Setback Distances:
comply with such provisions or this permit shall be deemed revoked.
Front Setback from Center Line '
IRear`Setb,/aa�ck-from=Rear=Prop=Line
CONSTRUCTION LENDING AGENCY JV !Side StreAt S' etback rN m C nter Line
—
I hereby affirm that there is a construction lending agency for the performance of the —SIA
`I
work for which this permit is issued. (Sec. 3097, Civil Code.) +'• Sid Setback from Propert L nja
Lender's Name p
Lender's Address liFS
- C B 1
This is a building TOR I
permit when properly filled out, signed and validated, and is subject to FINAL DATE PEC
° I. I
expiration if work thereunder is suspended for 180 days. Ieater Permit
I certify that I have read this application and state that the above information is correct. Issued by; s
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-. )e y
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
IST FL. SQ. FT. ® $
UNITS
COLL. AREA
SLAB GRADE
YARD SPKLR SYSTEM
2ND FL. SQ. FT.
HEATING (ROUGH)
STORAGE TANK
FORMS
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
DUCT WORK
ROCK STORAGE
FOUND. REINF.
POWER OUTLET
ROOF DRAINS
GAR. SQ. FT. ®
HEATING (FINAL)
OTHER APP.IEQUIP.
REINF. STEEL
DRAINAGE PIPING
CAR P. I SO. FT. ®
WALL SQ. FT.
DRINKING FOUNTAIN
SERVICE
FINAL INSP.
URINAL
SO. FT. ®
/
ay
WATER SYSTEM
ESTIMATED CONSTRUCTION VALUATION $
GRADING
cu. yd.
$ plus x$
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
—
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
VENTILATION
LAUNDRY TRAY
AIR HANDLING UNIT CFM
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 _
SO. FT. .@ c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ac
HOUSE SEWER
INSULATIONISOUND
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.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM _
/
ay
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 SIGNATURES/INITIALS
GARDEN WALL FINAL