9548 (BLCK)Ted4t 4 4v
Building 53_525 Avenida Cortez
Owner
Sohn S. Otternesw
Address 53-525 Avenida Cortez
P.O. BOX 1504 N ® .
78-105 CALLE ESTADO - t r
LA QUINTA, CALIFORNIA 92253
BUILDING: TYPE CONST. OCC: GRP.;
CityZip Tel.
Contractor
Owner/Builder
Address
State Lic. I City
& Classif. Lic. #
Arch., Engr.,
Designer
Address Tel.
City IZip ISt t#
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am Ilcensed'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.
'SIGNATURE DATE
OWNEWBUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the rfollowing
reason: (Sec. 7031.5,eualness and Professions Code: Any city or wunty which requires a
permit to construct, after, Improve, demolish, or repair any structure, prior to Its Issuance also
requiMe res
of the for
ase Lo v,Ncn�ter 8w(cons that he
is �SSecf� 0re of w
Olvislon 3 of the Business and, Professions Code, or that. he Is exempt therefrom, and the basis
tot the a0eged exemption. Any vbWbn of Section7031.5 by 'any applicant for a permit
sqNsch; the applicant to a.ch* penalty of not more than,Ove hundred dollars ($500).
as owner. of the property, or my employees with wages as their sole compensation, -will
o the work, and the structure is not Intended or offered for sale. (Sec. 7044, euisness and
Professions Code; The Contractors License Caw does not apply to an owner.of property who
buff 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.. N,,.bowever, the building
or 'improvement Is sold within one year of completion, the owner -builder will have the burden
of proving, that he dirt not bund or Improve for the purpose or safe.)
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-
struct the project (Sec. 7014, euekress end Professions Code: The. Contractors license Law
does not apply to sit owner or propertywho builds or Improves thereon, and who contracts for
such projects with a contractor(s) licensed pursuant ro the Contractor's License law.)
O. 1 am exempt under Sec P, C. for t 's reason -
Date OwniC
or
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I' have a certificate of consent to self -insure, or a certificate,of
Workers Compensation Insurance; or a certified copy thereof. (Sec. 3600, Labor Code.)
Policy No Comparly
❑ 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 collars (5100) valuation
or low.) •..
I certify that in the perfofmance of hq w for which Is•,permll,is,issued, I shall not
employ anY.ppee►son In an�rtian r so to ec me t to.lh b .t�o�pensatlon
Laws of CalnfomI
Date_ Own � >,;-'�7
�
NT:
NOTICE TO APPLICAt this, ce 'yam should become
subject to the Wonters' -satak provisions of Bre Labor Code, you must forthwith
comply *YM such provisions or th pemdf shall be deemed revoked.
CONSTRUCTIOWLENDING 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 1 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 sof this city to enter the above•,
mentioned property for Inspection purposes.
Signature of applicant Date
Mailing Address
city, state, zip
A.P. Number
9548
Legal Description
Project Description
121 of 8' block wall, 10' of 7' black stall
and 138' of 4' block wall
Sq. Ft. No: No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
KOUT: Planning approved S' and 7' wall
lumatea valuation 3,078
PERMIT AMOUNT
Plan Chk: Dep.
Plan Chk. Bal.
Const. - 6.3.00
Mech.
Electrical
Plumbing
S.M.I. .40
Grading
Driveway Enc.
Infrastructure
TOTAL 63.40
REMARKS
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 Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO.. PLUMBING FEES
1ST FL. SO. FT. a $
UNITS
SLAB GRADE
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL. SO. FT. a
FORMS
SEWER OR SEPTIC TANK
POR., SO. FT. a
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. a
POWER OUTLET
ROOF DRAINS
CAR P. I SO. Fr. a
OTHER APPJEOUIP.
DRAINAGE PIPING
WALL SO. FT. a
TEMP. POLE
DRINKING FOUNTAIN,
SO. FTa
GROUT
URINAL
ESTIMATED CONSTRUCTION VALUATION $
FINAL INSP.
WATER PIPING
NOTE: Not to be used as. property tax valuation'
WATER SYSTEM
FLOOR DRAIN
MECHANICAL FEES
_
o f
WATER SOFTENER
VENT SYSTEM. FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
REMARKS:
LAUNDRY TRAY
AIR HANDLING, UNIT CFM
KITCHEN SINK
ABSORPTION SYSTEM B,T;U,
TEMP USE PERMIT SVC
WATER CLOSET'
COMPRESSOR HP
POLE, TEWPERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER. B.T.U.
SO. FT. a c
BATH TUB
SO. FT. a c
WATER HEATER
MAX HEATER OUTPUT, B.T.U.
SO. FT. REBID a 1 Ya c
SEWAGE DISPOSAL
SO.FT.GAR a %c
HOUSE SEWER
MESH
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
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 APPJEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
Cu. yd.
3 plus : $
_
o f
LUMBER GH.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
/-;?1l .
!! EE I •�
1�( G / /������
7
REMARKS:
VENTILATION
FIRE ZONE ROOFING;
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIOWSOUND
FINISH GRADING
FINAL INSPECTION -
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINRYLLS
GARDEN WALL FINAL 7d