11379 (BLCK)P.O. BOX 1504 N o . 11379
Building 7&105 CALLE ESTADO Ill
-Address 5 1525 .IUARBZ LA QUINTA, CALIFORNIA 92253
Owner-,_ U
RICK MORRIS
Mailing
BUILDING: TYPE CONST. OCC: GRP.
Address
A.P. Number
City Zip Tel.
Legal Description 773-042-017
Contractor Project Description BLOCK WALT. 1651 X 6'
A & H CONSTRUCTION
Address
P 0 BOR 366
City Zip Tel.:
LA QUINTA 564 4832
State Lic. City
& Classjf. 487854 Lic. # 626 Sq. Ft. No. No. Dw.
Arch., Engr., Size Stories Units
Designer New L11 Add ❑ Alter ❑ Repair ❑ -Demolition ❑
Address Tel. 1651 X 6i* BLOCK WALL
City Zip State
Lic. #
lair LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that.l am licens€I 'Under provisions of Chapter 9 (commencing with Section
7000) of Division the Business and.Profess' ns.Eode, and my license is in full force and
effect.
SIGNATURE DATE - -
OWNER -BUILDER DECLARATION Estimated Valuation
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 AMOUNT
requires the applicant for such permit to file a signed statement that he is licensed pursuant to PERMIT '
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Division 30IF 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 •Plan Chk. Dep. _
subjects the applicant to a civil penalty of not mare than five hundred dollars ($500).
❑ I, as owner of the property, or my employees with wages as their sole compensation, will Plan Chk. Bal. 72.00
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and Const.
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 did not build or improve for the purpose of sale.)
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con- - Plumbing
slruct 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. .50
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
Grading
❑ I am exempt under Sec. B. & P.C. for this reason
Driveway Enc. y }
Date Owner Infrastructure
r
WORKERS' COMPENSATION DECLADATION
I hereby affirm 'that I have a certificate offconsent to self -insure, or a certificate of
Worker's Compensation Insurance, or a cdlt fi •'copy thereofC(581'38 Labor Code.)
(policy No. Company j)
1 Adopy is filed with the city. O Cerblfied copy.is hereby furnished.
TOTAL $72.50
CERTIFICATE OF EXEMPTION FROM REMARKS 1��1j?k) = �j{?ix' "' ?,•' tt`
WORKERSCOMPENSATION INSURANCE
his section need not be completed if the '�'
R p pemig'7is !or one hundred dollars ($100)- valuation
Corless.) - �
I certify that in the performance of the work for which this permit is issued, 1 shall not
employ any person in any manner so as to become subject to the Workers' Compensation
t• Laws of California.
Date Owner
NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become ZONE: BY:
subject to the Workers' Compensation provisions of - the Labor Code, you mustforthwith
comply with such provisions or this permit shah be deemed revoked. 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 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
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. 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 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
BONDING
FLOOR DRAIN
MECHANICAL FEES
FORMS
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APPJEOUIP.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
TEMP. POLE
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
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID @ 11/. c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ic
HOUSE SEWER
REMARKS:
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 kv
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 4�
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
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION -
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL