003513 (BLCK)TA i if
P.O. BOX 1504 No,. 003513
Buildingr 78-105 CALLE ESTADO
54'-511 Avenida' Avenida 4u�ez LA QUINTA, CALIFORNIA 92253
Owner _
S Scott a Elizabeth Sharer BUILDING:. TYPE CONST. - OCC: GRP.•
Mailing'
Address � � A.P. Number. 774-262-027
City ZipTel.
j, lits . 92253 Legal Description
Contractor Project Description 61 Fi ch X 501 Of Wood fence
C er/Auilder
Address .
"City Zip Tel.
State Lic. City
& Classif. Lic. # Sq. Ft. No. No. Dw.
Arch., Engr.,
Size Stories Units
. .. - .. ,
Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address Tel.
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I herebyaffirm that I am licensed under provisions -of Chapter 9 (commencing with'Section - y+
7000) of Division 3 of the Business and Professions Code, and my license is in full force and
effect.
SIGNATURE DATE '
OWNER -BUILDER DECLARATION ' ' Estimated Valuation c
I hereby affirm that I am exempt from the Contractor's License Law for the following $300.40
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 A 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 '3 of lhe' 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 penally of not more than five hundred dollars ($500): Plan Chk. Bal.
'
❑ 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 COnSt. '��
Professions Code: The Contractor's License Law does not apply to an owner of. property who - a a .
builds or improves thereon and who does such work himself or throughhisown 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.
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) -
Grading
.❑ 1 am exempt under Sec. B. & P.C. for this reason
Driveway Enc.
Date Owner Infrastructure
WORKERS' COMPENSATION'DECLARATION
Thereby 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 '
0 Copy is filed with the city. ❑ Certified copy is hereby. furnished.
_ TOTAL
CERTIFICATE OF EXEMPTION FROM REMARKS
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, alter making this Certificate of Exemption you should become
ZONE:
BY:
subject to 'the Workers' Compensation' provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall 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.
try `8
3
I certify that I have read this application and state that the above information is correct.
Issued by:
Date 7 Permit
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 -
mention . ed property for inspection purposes.
Validated by:
Signature of applicant Date
Mailing Address
, Validation:
City, State, Zip
HARD COPYI
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
2ND FL. SQ. FT. ®
POR. SO, FT, ®
GAR. SQ. FT. ®
CAR P. Q. 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 APPJEQUIP.
LAUNDRYTRAY
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.
SQ. FT. ® c
BATH TUB
SQ. 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
ROCKSTORAGE
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$-_$-
lusx$_$ROOFING
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.
�L ENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL