003389 (BLCK)Building
Address
53-255 Avenida
Owner
Fence
the provisions of the: Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Charlps Maniaarn
Mailing
Plan Chk.. Dep.
Address
City
—
Zip
do the work, and the structure is not intended or offered for sale: (Sec. 7044, Buisness and' .
Professions Code: The
Const.
Contractor's License Law does not apply to an owner. of properfy..who
builds or improves thereon and who does 'such work himself or through his own employees,
Contractor
provided that such improvements are not Intended or offered for sale. IF.however, the building
Bata ACL INE FEHPE ;
,Address ..
.
83-150 Ave. 52
' City- . -
. ..-
Zip
State Lic.
& Classif.: 264118
Arch., Engr.,
Designer -
Address
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
Tel.
Tela
30A ni
City - .
Lic. #
Tel
No. 003389
BUILDING:. TYPE CONST. OCC: GRP.
A.P. Number
Legal Description
Project Description!�pA�£�
4
City JZip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that ham licensed under provisions of Chapter 9 (commencing with Section
70 00) of Division 3 of the�Business and Professions,Code,aand my license is in full force and
effect. s
_SIGNATURE /" . DATE
OWNER -BUILDER DECLARATION EStlmated 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
Sq. Ft. No.
Size Stories
No. Dw.
Units
New ❑ Add ❑ Alter ❑. Repair ❑
Demolition ❑
1501
6'
Wood
Fence
the provisions of the: Contractor's License Law, Chapter 9 (commencing with Section 7000) of
'
Division 3 of the Buslhess and Professions Code, of that. he 'is exempt therefrom, and the basis -
for thealleged Any Section 7031.5 by 'any for
Plan Chk.. Dep.
exemption. violation of applicant a permit
'subjects the applicant to a civil penalty of not more than live'hundred dollars ($500). • • .-
Plan Chk. Bal.. '
O 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
Const.
Contractor's License Law does not apply to an owner. of properfy..who
builds or improves thereon and who does 'such work himself or through his own employees,
t t onn
permit io construct, alter, Improve, demolish, or repair any structure, prior to its issuance also
1'r,
rAMOUNT
requires the applicant Jor 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 3 of the Buslhess and Professions Code, of that. he 'is exempt therefrom, and the basis -
for thealleged Any Section 7031.5 by 'any for
Plan Chk.. Dep.
exemption. violation of applicant a permit
'subjects the applicant to a civil penalty of not more than live'hundred dollars ($500). • • .-
Plan Chk. Bal.. '
O 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
Const.
Contractor's License Law does not apply to an owner. of properfy..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
struct the project. (Seca 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
El I am exempt under Sec.. 8. 8 P.C. for this reason.
Driveway Enc.
Date owner
Infrastructure
WORKERS' COMPENSATION DECLARATION
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
❑ Copy is filed with the city. O. Certified copy is hereby furnished. .
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's
Laws of California.
Date Owner
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.
CONSTRUCTION LENDING AGENCY
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.)
Lender's Name
Lender's 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. I -
I certify that I have read this application and state that the above information is correct.
I agree to comply with all city and county ordinances and state laws relating to building .
construction, and herebyauthorize representatives of this city to enter the above-
mentioned property for inspection purposes. "
Signature of applicant Date
Mailing Address
City, State, Zip
HARD COPY
Y
TOTAL S20.00
REMARKS rte' 11 hh !1 CC+.
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 �1. % Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
MD FL. SQ. FT. @
.POR. SQ. FT. ®
GAR. SQ, FT. ®
CAR P. SQ. FT.
WALL SQ. 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
SLAB GRADE
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
ROUGH WIRING
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
DUCT WORK
LAUNDRY TRAY
AIR HANDLING UNIT CFM
GAS (ROUGH)
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
WATER HEATER
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
ISEWAGE DISPOSAL
BOND BEAM
SQ.FT.GAR ® 3/4c
HOUSE SEWER
$
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
FO MS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP./EQUIP.
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
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC. „.
FENCE FINAL,
Cl,1 V A J JIV19A 1 V /70/1111 IALA,
GARDEN WALL