04987 (BLCK)Building
Address
T&t u
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
Douglas w s+
Mailing _ ' -
Address
City Zip Tel.
La Oukats 92253
43-695 Cartel Circle
& Classif. 317340 1 Lic. # `655
Arch., Engr.,
Designer
Address
City ipI State
I
LICENSED CONTRACTOR'S DECLARATION
1 hereby affirin. that 1 am Ikensed, undarprovisl ins of Chapter 9 (commencing with section
7000) df Dtvlelon 3 of the Rustiness and Professions Code `artdirly license Is in full force and
effect.
SIGNATURE'-' r - DATE
OMIN61-Bu1f.DER DECLARATION
I hereby affirm that 1 am exempt from the Contractors License Law for the following
reason: (Sec. 7031.5,8ushess and PrMrty asakins Code: ACRY or county whkalr requires a
permit, to construct, alter, kiquovst darrre5 1 or r6pa6 any structure, prior to Its Issuance also
requires the applicant for Such pamrlt ED We a signed statemeral that he Is licensed pursuant to
tee provisions or the CurrLracOork License Law, Chapter 9 (commencing with Section 7000) of
Olvision 3 of the Business and Professions Code, or that. he is exempt therefrom, and the basis
for the apeged exemption. Any nictation of Section 7031.5 by any applicant for a permit
subjects the appacam td'a rhdpenahy.of not mare than the hundred do8ars (5500).
❑ I, as owner of the property, or myemployees with wages as their sole compensation, will
do the work, and the structure Is not intended or offered for sale. (Sec. 7044, Suisness and
Professions Coder The Contractor's License Law does not apply, to an owner of property who
builds or= thereon and who does such work himself or through his own employees,
Oro~ that auelr Brrprovemards are not intended orofferedfoi,sele. M, however, the building
or
tmprovemenf Is sold wltlekr one year of u, " 1, Liort, Has owner-buoder will have the burden
of proving that he did not braid or irpore for the purpose of sale.)
❑ 1, as owner of the property, am exclusively contracting with licensed contractors to con-
struct the project (Sao. 7044, Business and Professions Code: The Contractor's License Law
does not apply to an owner of property who bu kis or brrproves thereon, and who contracts for
such projects with a contractor(s) ltcerrsed purst and to the Carbactor's License Law.) .
❑ I am exempt under Sem------R 6 P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a cer irieate of consent to self -insure, or a certificate of
Workers Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. Company
❑ Copy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EKEMPTION FROM
WORKERS COMPENSATION INSURANCE
(This Section need not be coir ttkted If Me pemd is for one hundred dollars ($100) valuation
or less.)
1 certity'that in the performance of thg wok for which this permit is issued, I shall not
employ any
omrresia. ppeeoon in any manner so as to became subject to the Workers' Compensation
Laws of.CaUt
Dat Owner
NOTICE TO APPLICANT: t, altar malrig tale Certificate of Exemption you sfpuid become
subject to the Workers' ConQerrsalten provisiooe. of the Labor Cale, you must foithwith
comply with such provftb tsar 1128 pwn* shad be damned rewked.
CONSTRUCTION LENDING AGENCY
Ihereby affirm that there is a construction lending agency for the performance of the
work form h this permit u ISSued (Sec. 3097, CivilOmb.)
Lenders Name
Lenders Address
This is abuilding permit when properly filled cut, signed and validated, and is subject to
expiration it work thereunder is suspended for 100 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 aufhortze representatives -of this city to enter the above-
mentioned property for inspection purposes.
Signature of applicant _ Date
Mailing Address
City, State, 2Ip
No. 04987
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number 774-102-002
Legal Description
Project Description Retaininlz wall 1001
30" hich R 241 of Garda,n Nall 24" h1ah
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 / 44rmit
Validated by:
Validation:
Sq. Ft.
Size
No.
Stories
No. Dw.
Units
New ❑ Add ❑
Alter ❑
Repair ❑ Demolition ❑
Estimated Valuation
$1,860
PERMIT
AMOUNT
Plan Chk. Dep.
Plan .Chk. Bal.
Const.
$31-00
Mech.
Electrical
Plumbing
S.M.I.
.50
Grading
Driveway' Enc.
Infrastructure
TOTAL
REMARKS
_
ti Yr'I�i..{'I71 »'�'"��.''�}..y: .. 1: KFC' o: , r".i i .'
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 / 44rmit
Validated by:
Validation:
NO. ELECTRICAL FEES
NO. PLUMBING FEES
UNITS
'►
COLI. AREA
YARD SPKLR SYSTEM
MOBILEHOME SVC.
BAR SINK
POWER OUTLET
ROOF DRAINS
FORMS
DRAINAGE PIPING
ROUGH WIRING
DRINKING FOUNTAIN.
ROCK STORAGE
URINAL
GAS (ROUGH)
WATER PIPING
HEATING (FINAL)
FLOOR DRAIN
REINF. STEEL
WATER SOFTENER
SIGN
WASHER(AUTOXDISH)
GARBAGE DISPOSAL
WATER HEATER
LAUNDRY TRAY
FINAL INSP,
KITCHEN SINK
TEMP USE PERMIT SVC
WATER CLOSET
POLE. TEMIPERM
LAVATORY
AMPERES SERV ENT
SHOWER
SO. FT. ® c
BATH TUB
SO. FT. ® c
WATER HEATER
SQ. FT. RESID ® 1 W c
SEWAGE DISPOSAL
SQ:FT.GAR ® 3Ac
HOUSE SEWER
REMARKS
GAS PIPING
PERMIT FEE
PERMIT FEE
PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLI. 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 APPJEQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP,
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ Plus X$
=$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
,J
REMARKS
VENTILATION
FIRE 'ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
�bzTHING `� 0
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESANITIALS
GARDEN WALL FINAL