003091 (BLCK)T4'ht.
P.O. BOX 1504
Building 78-105 CALLE ESTADO
Address 52-285 Avenida Cortez LA QUINTA, CALIFORNIA 92253
Owner
D011 Hansell
Mailing
Address n^v Z A17
City Zip Tel.
La (?urota . 1 92253- .
Contractor
No. 003091 ,
BUILDING: TYPE CONST. OCC: GRP.:
A.P. Number 373-201"`022 Lot 14
) Legal Description
Project Description ��taining wall
State Lia City
& Classif. Lic. # Sq. Ft. No. No. Dw.
Arch., Engr.; " -
Size( a-• Stories Units •
Designer New Q Add ❑ Alter ❑. Repair ❑ Demolition ❑
Address
Tel.
CityZip
State
.. - ' '
Lic. #
LICENSED CONTRACTOR'S DECLARATION
•H -
I 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.
SIGNATURE DATE
OWNER -BUILDER DECLARATION
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
Estimated.Valuation
SQ®.00
PERMIT - AMOUNT '
e
permit to construct, after, improve, demolish, or repair any- structure, prior to its issuance' also
requires the applicant for such permit to file a signedstatement that he is licensed pursuant to
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
' 'Division 30f the Business and Professions Code, or that. he is exempt therefrom, and the basis -
for the alleged exemption. Any violation or Section 7031.5 by 'any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars ($500).
. ❑ I, as owner of the property, or my employees with wages as their sole compensation, will
-
Plan Chk. Dep.
Plan Chk. Bal. •
Const. " V V
•
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
.
Mech.
buildsOf-improvesthereon and who does such work himself or through his own employees,
provided that such improvements are not intended or offered for sale. If,, however, the building'
,
'Electrical -
or improvement is sold within one year of completion, the, owner.builder will -have the burden
of proving that he did not build or improve for the purpose of sale.)
Plumbing
0 1, 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
S.M.I. k �a•
• such projects with contractor(s) licensed pursuant to the Contractor's License Law.) -
0 1 am exempt under Sec..B. B. & P.C. for this reason.
I
Grading
Driveway Enc.
f Date � ^ Owner {� -�� e - - _ _—_ _
Infrastructure
WORKERS' COMPENSATION DECLARATION
hereby affirm that I have a certificate of consent to self -insure, of 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.
TOTAL $41.75
CERTIFICATEOF EXEMPTION FROM
1 WORKERS' COMPENSATION INSURANCE
REMARKS.
F (This section need not be completed if the permit is for one hundred dollars ($100) valuation
I or less.) -
I I certify that in the performance of the work for which this permit is issued, I shall not
6 employ any person in any manner so as to become subject to the Workers' Compensation
i 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 shall be deemed revoked. -
ZONE: BY:
Minimum Setback Distances: -'
Front Set,back;f'romi-Cenfef'•`Linb,4-.-**x_0; iA .
iback eo yip a Prop. i t
Rear Setback from Rear Prop. Ltne
CONSTRUCTION LENDING AGENCY
Side Street Setback from Center Line
I hereby affiim 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
' 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 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 sof this city to enter the above-.
mentioned property for inspection purposes.
FINAL,DATEINSP9®�L7 ECTObbermitR
Issued by:' Date %i7 }P
-
Validated•by:
Signature of applicant Date
Mailing Address
Validation:
T
City, State, Zip
HARD COPY
-
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SQ. FT. ® $
UNITS
SLAB GRADE
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL. SO. FT. ®
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
GAS (ROUGH)
METER LOOP
GAR. SO. FT. ®
POWER OUTLET
I ROOF DRAINS
GAS (FINAL)
TEMP. POLE
DRAINAGE PIPING
CAR P. SO. FT. ®
ROUT
WATER HEATER
WALL SQ. FT.
FINAL INSP.
DRINKING FOUNTAIN
SQ FT ®
WATER SYSTEM
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
FIRE ZONE ROOFING
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
LATHING
SQ. FT. ® c
WATER HEATER '
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 1+/a c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ac
HOUSE SEWER
FINISH GRADING
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE LPL.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
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
7INF. STEEL o r 9
GAS (FINAL)
TEMP. POLE
ROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ -Plus-x$-=$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
_
DEC Q 1 7
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS.
GARDEN WALL FINAL