05604 (BLCK)Building
Owner
ot
P.O. BOX 1504 No.
78-105 CALLE ESTADO
LA QUINTA„CALIFORNIA 92253
~ J BUILDING: TYPE CONST. OCC: GRP,
A.P. Number 774-244-013
$2525 JUAM
Coat e -11a Valley Laud
Mailing
Address 247 H. Tahquitz Way #2
city alm Spriaga Zip 92262
Starr Co=trmtian
Address
i983�€�
City
State Lic.
& Classif. 3979.34
Arch., Engr.;
Designer
Address
Tel.
05604'
al Description Lot 4 $Ik. 167 Unit 17
ject Description Retainiog Wall;
• - 00 feat •S-iz> h wall 215L1 - 2'819 high
City
Lic. # 695 Sq. Ft. No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Tel.
CityZip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that Lam licensed under provisions of Chapter 9 (commencing with Section
70pp) of Division 3 of:the Business and Professions Code, and my license is in full,force and
effect
SIGNATURE DATE
OWNEWBUILDER DECLARATION
hereby affign that I am exempt from the Contractors License Law for the following
reason (Sec- 7031.5,8usumnss and Professions Code: Any city or county which requires a
perm to Construct, after. I prove. demolish. or repair any structure,- prior to its issuance also
requ es Ore appicant for such permit to file a signed statement that he is licensed pursuant to
the provisions of the Contractors License Law, Chapter 9 (commencing with Section 7000) of
avfsbn 3 of the Business and Professions Code, or that. he is exempt therefrom, and the basis
for the Moged exemption. Any violation of Section 7031.5 by 'any applicant for a permit
subjects the applicant to a mvi penally 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 Contractoes License Law does not apply to an owner of property who
Ixnr7ds or improves thereon and who does such work himself or through his own employees,
provided that such improvements are not intended or offered for safe. If, however, the building
or improvement is said wduin ane year of completion, the owner -builder will have the burden
of proving that he did not build or rrprove for the purpose of safe.)
❑ 1, as owner of the property, am exclusively contracting with licensed contractors to con-
struct
onstruct the project (Sec. 7044, Business and Professions Code: The Contractor's License Law
does not apply to an owner of property who bufids or improves thereon, and who contracts for
such projects with a contractors) licensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec B. & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION, 1 v
1 hereby affirm that I have a certificate of consent to self;irisure„or a certificate of
Workers Compensation Insurance, or a certified copy thereof.;(Sec. 38.00, Labor Code.)
Policy No Company —ell 011-1-
0
11- .”❑ Copy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(rfris section need not be completed ff the permit is for one hundred dollars ($100) valuation
of less.)
1 certify that in the perfomlence 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 Owner
NOTICE TOM
N, after making this Certificate of Exemption you should become
subject to the %bikers' Compensation' provisions of the Labor Code, you must forthwith
Comply math such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
1 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.)
Lenders Name---
Lender's
ame
Lenders Address
This is a building permit when properly filled out, signed and validated, and is subject to
expiration it work thereunder is suspended for 180 days.
certify that I have read this application and state that the above information is correct.
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.
Signature of applicant Date
Mailing Address
City, State, Zip
Estimated Valuation _
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
29.2:i
:i
Mech.
Electrical
Plumbing
S.M.I.
.14.
Grading
Driveway Enc.
Infrastructure
'
TOTAL
g
REMARKS
,r1:' .i f?: aR{k .;<tSr'rt ,fi { L..f7' ,af , Yru 3 A
.tet "'GaY'N. v Y .t + c.v ,out.. .” .�. .. . •
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE INSPECTOR
Issued by: Date 4/6/89 Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES w
1ST FL. SO. FT. ® $
UNITS
SLAB GRADE
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL. SQ. FT.
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING.
MOBILEHOME SVC.
BAR SINK
POR. SO. FT.
GAS (ROUGH)
METER LOOP
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
GAS (FINAL)
TEMP. POLE
DRAINAGE PIPING
CAR P. SQ. FT. ®
GROUT -
WATER HEATER
WALL SQ. FT.
FINAL INSP.
DRINKING FOUNTAIN.
SQ FT a
WATER SYSTEM
URINAL
ESTIMATED CONSTRUCTION VALUATION $
=$
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
IWATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
VENTILATION
LAUNDRY TRAY
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.
SQ. FT. @ c
BATH TUB
LATHING
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1% c
SEWAGE DISPOSAL
SQ.FT.GAR ® V4c
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
1
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
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 SIGNATURESJINITIALS
GARDEN WALL FINAL