003764 (BLCK)-% _
Building
Address 53-300 Juarez -
Owner
tog rn
Mailing
Address P. 0. Box 2379
City Zip
. La Quinta 9225.3
Contractor
ress.. .
State Lic.
& Classif.
Arch., Engr.,
Designer
4
P.O. BOX 1504 NO. 003764
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
Tel.
564-7411
Tel.`
.City
Lic. #
Address Tel.
City Zip State
. Lic. If
LICENSED CONTRACTOR'S DECLARATION,_
1 hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of the Business and Professions Code, and my license is in full force and
effect. ti _
_ SIGNATURE w 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, after, improve, demolish, or repair any structure, prior to its issuance also
requires the applicant for such permit to rile 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). ' 1
❑ 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. N, however, the building
or improvement is sold within one year of completion, the owner -builder will have the burden
or proving that he did not build or improve for the purpose or sale.) .
❑ 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 certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. - Company
O Copy is filed with the city. ❑ 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 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
Laws of California.
Date' Owner "
NOTICE TO APPLICANT: If, 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 shalt 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
Lenders Address
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.
1 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 hereby authorize representatives of this city to enter the above-
mentioned property for inspection purposes.
Signature of applicant Date
Mailing Address
City, State, Zip
HARD COPY
BUILDING: -TYPE CONST.. _OCC. GRP.
A.P. Number 774-071- qO3
Legal Description
Project Description 311' X 21 high regaining wall
_aad -60" X 2#. high -retain-ing waif
REMARKS
Z iit�:iiJtx 1 f e:y�q rti •• .
ZONE:
BY:
Minimum Setback Distances:
Front Setback from Center Line
3q. Ft.
Size
No.
Stories
No. Dw.
Units
New ❑ Add ❑
Alter ❑
Repair ❑ Demolition ❑
FINAL DATE
INSPECTOR
Issued by:
Date 3/31/8Permit
Validated by:
Validation:
Estimated Valuation
$2,406
PERMIT.
<
x.
AMOUNT
Plan Chk. Dep. `
Plan Chk. Bal.
Const..
$39.50
Mech. ,
Electrical
Plumbing
S.M.I.
JS�
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS
Z iit�:iiJtx 1 f e:y�q rti •• .
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 3/31/8Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING -FEES
1ST FL. SO. FT. ®, $
2ND FL. SQ. FT.
POR. SQ: FT. ®
GAR. SQ. FT. ®
CARP. SO. FT.
WALL SQ. FT. ®
SQ 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 APP./EQUIP.
LAUNDRYTRAY
AIR HANDLING UNIT CFM,
TEMP. POLE
KITCHEN SINK
ABSORPTION SYSTEM. B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET'
COMPRESSOR HP
POLE, TEM/PERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER. B.T.U.
SO. FT. p c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
" SQ.FT.GAR ® 3/ac
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
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FO ND: REINF. / /,
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP./EQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM L 6 c
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
NSYt%; I Uh'A WUNA I URCJIINI 1 IALS,
GARDEN WALL FINAL