9499 (BLCK)4P.O-.
BOX 1504 1 �. No. 9499
Building. �m,{�6s"� a��bt� %�cti3aw 7&105 CALLE ESTADO f t{
Address LA QUINTA, CALIFORNIA 92253 f' r
Owner .�3 V y
Richard Schwerner
Mailing BUILDING: TYPE CONST. OCC: GRP.
Address Same A.P. Number
City Zip Tel.
La Quinta 9225.3 345-3600 Legal Description
Contractor
Address
State Lic.
& Classif.
�Ul�d�� Project Descrlptlon
351 of 51 block wall
559 of 6` Mock gall
Zip I I Tel.:
Lic. # Sq. Ft. No. No. Dw.
Size Stories Units
Designers
New ❑ Add ❑.
Alter ❑ Repair ❑ Demolition ❑
Address
Tel.
City
Zip
State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
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
1 hereby affirm that I am exempt from the Contractors License Law for the following
reason: (Sec. 7031.5,Buslness and Professions Code: Any city or county which requires a
permit to construct, alter, improve, demoDsh, or repair any structure, prior to its issuance also
requires the applicant for such permit to We a signed statement that he is licensed pursuant to
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Division 3 of the 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
subjects.the applicant to a civil penalty of not more than five hundred dellars.($500).
�'
fl, as owner of the property, or my employees with wages as their sole compensation, will .!
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and
Professions Code: The Contractor's License Law does not apply to an owner of property who
builds or improves, thereon and who does such work himself or through his own employees,
provided that' such improvements are not intended or offered for sale. 11, however, the building.
or improvement is sold within one year of completion, the owner-buader will have the burden
of proving that he did not build or improve for the purpose of sale.), ...
❑ I, as owner of the property, am exclusively contracting with licensed contractors.to con-
• struct the -project. (Sec. 7044, Business and Professions Code: The. Contractor's License Law
does not apply to an owner of property who builds or onproves thereon, and. who contracts for
- such projects with a contractor(s) licensed pursuant to the Conbactor's License Law.)
O 1 am exempt under Sec. a_ & P.C. for this reason r
' , ,,
Estimated Valuation
�132�'�5
PERMIT
'
AMOUNT
Plan Chk. Dep.
-
Plan Chk. Bal
r '
COr18t.
'3 a 4th
w• 1
Mech.
Electrical
Plumbing
S.M.I.
m 3L;
Grading
Driveway Enc.
Date Owner s '. f � f ��('9l rf l-ir 'f it me", j
Infrastructure
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a aertificate'of consent to self -insure, or a certificate of
' Worker's Compensation Insurance, ora certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. .Company
❑ Copy is filed with the city. O Certified copy is hereby furnished. .
TOTAL
TT3
CERTIFICATE OF EXEMPTION FROM .
WORKERS' COMPENSATION INSURANCE
(This section need not be completed ff the pemul is for one. hundred dollars ($ 100) valuation
or less.)
I certify that in the performance of thq•work for which this permit is issued, I shall not
=any person in any marl err o-as,to'become subject to the Workers' Compensation
Laws of California. / j j s ,�
Date Owner r �� �i dill:• ! fO. f k'/,;/. i A3i �t1
NOTICE TO APPLICANT: If, aRere`making this Certificate or Exemption -you- should become
subject' to the Workers' CompensaUon provisiais or the Labor Code; you must forthwith
comply with such provisions or this permit shall be deemed 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. 3097, C" Code.)
Lender's Name
Lender's 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. '
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 -of this city to enter the -above-.
mentioned property for inspection purposes.
Signature of applicant Date
Mailing Address
City, State, Zip
REMARKS
IV OW K -i ri .I f ry l "L. L
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
IST FL. SO. FT. ® $
UNITS
COLL. AREA
2ND FL. SO. FT.
YARD SPKLR SYSTEM
POR. SQ. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SQ. FT.
ROUGH WIRING.
DRAINAGE PIPING
WALL SQ. FT.
FOUND. REINF.
DRINKING FOUNTAIN.
SO FT ®
GAS (ROUGH)
URINAL
ESTIMATED CONSTRUCTION VALUATION $
OTHER APPJEQUIP.
WATER PIPING
NOTE: Not to be used as property tax valuation
GAS (FINAL)
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM. FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
WATER SYSTEM
LAUNDRY TRAY
AIR HANDLING UNIT CFM
=$
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
VENTILATION
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1% c
SEWAGE DISPOSAL
SO.FT.GAR ® 314c
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
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
REMARKS:
VENTILATION
FIRE ZONE ROOFING:
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION z L
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL