04988 (BLCK)mlu
Building
Address 53-520 Cortez
Owner
DouRl.as & Hazel 11.oafra
rvuurv:aa Same
City Zip Tel.
Ls Oui tat 92253
43-695 Carnal Circle
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
Palm Desert 1 92260 1 345-5440
State Lic. I City
A Classif. 317340 Lic. # 655
Arch., Engr., -
Designer
Address
LIC. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter -9 (commencing with Section
=01
Divislon.3 of the Business and Professions Code,,," my license is in full force and
SIGNATURE DATE
owNER•ButwEA DEcIAMnoN
I hereby affirm that I am exempt from the Contractors License Law for the following
reason (Sec- 703IS. f khess and Pre/nasions code: Any ofty or comfy which requires a
permit to oons6iiq, aaer, "Prom denhuasA. or repair any abucbue, prior to 110 issuance also
M provfsf�ons the (�aontra�c[ors Licensepermit Law. a (corrmr�mr��y � W7000) M
Dkidw 3 or'the Buskresa and Professlana Code. or that. he is exempt therefrom, and the basis
for the sQagod exenlptien.. Any vlofation of Section 7031-5 by any for a pemoT
andtecta the appfkard ro a penalty of not more than Ove hundred I a s ($500)-
11 1, 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, eulsness and
Professions Code: The Cw*actor8 License Law does not appy to art owner of property who
b uft or &nWoves Merron and who does such work hbmtelf or through his own employess,
piovfded that such brproveinents ars not intended or offered for sale. f, however, the buadIng
or hyprovermenf is sold waft ora year' of completion, the owner folder wig have the burden
W proving that he did not build or Lrprove for the purpose of sale.)
0 1, as owner of the property, am exclusively contracting with licensed contractors to con-
struct
on
stnrct the project (Sec. 7044, Busihess and Professions Code: The Witractora License Law
does not apply to an owner of property who builds or irrproves thereon, and who contracts for
such priojects rah a cmhacfor(s/ licensed pursuant to Ila Contractor's License Law.)
❑ 1 am exempt under Sec S. 6.P -C. for this reason
Date owner
WORKERS' COMPENSATION DECLARATION
Worker affirm that I have a certificate of consent to -self -insure, or a.certificate of
pensaUon Insurance, or a certified copy thereof. (See-, 3800, Labor Code.)
Policy No —Company
❑ Copy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS'COMPENSATIONINSURANCE
(This seetirsr need not be cmprleled O Me permf is for one hundred dtrsars ($100) vapration
or less.) .
1 certify that In the parformance.of the. work.for which this permit is issued, I shell not
Laws M Californian in any manner so as to become subject to the Workers' Compensation
Ufa pwrueY
hI AE TO APPLiCANT: R, after nabrig Ilhis Certificate of Exenptbn you should become
SUNG r to the %W km , Compensation provisions' of the Lebon Code. you most forthwith
oonpy with such provisions or this permit shelf be downed 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. 3087, CM Code.)
Lenders Name
L.ender's Address
This.is abuilding permit when properly filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days.
I 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 -
merdloned property for inspection purposes.
Signature of applicant Date
Mailing Addrsas
City, Sb* Zip
No. 04988
11LDING: TYPE CONST. OCC: GRP.•
P.,Number 774-102-001
Description
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
tDescription
Retaining
vial .
1001
Plumbing
R Ld.•.L
—.,. 2 9A41 —a
.. &A....
—II AA20 L♦si
Sq. Ft. No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
• r•
.PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
$31-00
Mech.
Electrical
Plumbing
S.M.I.
h
Grading,
Driveway Enc.
Infrastructure
TOTAL
REMARKS
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line.
FINAL DATE INSPECTOR
Issued. by: Date 12 12 49rmit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® S
UNITS
SLAB GRADE
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL. SO. FT. @
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING,
MOBILEHOMESVC.
BAR SINK
POR SO FT ®
GAS (ROUGH)
METER LOOP
GAR. SO, FT_ ®
POWER OUTLET
ROOF DRAINS
GAS (FINAL)
TEMP. POLE
DRAINAGE PIPING
CAR P. SO. FT. ®
GROUT
WATER HEATER
WALL SO. FT. @
FINAL INSP.
DRINKING FOUNTAIN
BOND BEAM
WATER SYSTEM
URINAL
S. FT a
=$
LUMBER GR.
ESTIMATED CONSTRUCTION VALUATION E
FINAL INSP:
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
VENTILATION
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
FIRE ZONE ROOFING
LAUNDRY TRAY
AIR HANDLING UNIT CFM
FIREPLACE
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.
SO. FT. ® c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1 Vi c
SEWAGE DISPOSAL
SO:FT.GAR ® 114c
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
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING,
DUCT WORK
ROCK STORAGE
I(&OUND. REINF. - /�(
00 (,!
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.
y plus xE
=$
LUMBER GR.
FINAL INSP:
FRAMING
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAP, FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
'
GARDEN WALL FINAL 71