04146 (BLCK)Building r '78-535 Ultimo
Address
Owner,
Kathy Bissell
•
4
i. P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
Mailing ,1.
Address P • 0. BOX 114 �
City Zip Tel.,
3.t 1 a X32253 -
664-1613
Contractor
Address
ity lZip
State Lic. City
& Classif. Lic. If
Arch., Engr.,
Designer
r Address„ Tel.
• 4
AS.,.
Cityt - 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
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
,y r
6BUIL04146-
BUILDING:
DING: TYPE CONST. OCC. GRP.
A.P. Number 769-061—Q04
Legal Description
T• . ✓
Project Description > t , X 601 wood fence
A• •
Sq. Ft. No. No. Dw.r
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation �E� • 00
permlt,to construct, alter, Improve, demolish, or repair any structure, prior to its Issuance also
to file that he is licensed to
PERMIT
,
AMOUNT
requires the applicant for such permit a signed statement pursuant
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
Any Section 7031.5 by 'any for
Plan Chk. Dep.
- for the'@alleded.jexemplion. violation of applicant a permit
subjecti the applicant I a civil penalty of not more than five hundred dollars ($500).
Plan Chk. Bal.
- .
O I, as.owner of thii property, or my employees with wages as their sole compensation, will
"j do the work; and the structure is not intended or offered for sale. (Sec. 7044, Buisness and
Const.
00
' 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,
Mech.
provided that such improvements are not intended or offered for sale. If, however, the building
of improvement is sold within one year of completion, the owner -builder will have the burden
Electrical
of proving that he did not build or improve for the purpose of sale.)
-
`,` 0 I, as owner,of the property, am exclusively contracting with licensed contractors to con-
Plumbing
^
' struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law
,
does hot -apply to an owner of property who builds or improves thereon, and who contracts for
S•M.I.
•- '
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
Grading
❑ 1 am exempt under Sec. B. & P.C. for this reason ti f
_
Driveway Enc.
�!
Date Owner x!r Y� f �l l'
' •`
Infrastructure
f• 1
WORKERS' COMPENSATION DECLARATION
• I hereby affirm that I have a certificate of consent to self -insure, or a certificate of
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
'
Policy No. Company
❑ Copy is filed with the city. O Certified copy is hereby furnished.
TOTAL
CERTIFICATE OF EXEMPTION FROM
REMARKS
WORKERS' COMPENSATION INSURANCE
(This section need not be completed it the permit is for one hundred dollars ($100) valuation
or less.)
I certify that in the performance of the work for which this permit is issued, I shall not
ry
10 J�yt� ,� �ti�43� l; ;� � 5►;(jt;}
employ any person in any manner so as to become subject to the Workers' Compensation
,;•,
t
Laws of California
ts::l"+t1 w3
Date Owner
NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become
ZONE:
BY:
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
Minimum Setback
'
Distances:
comply with such provisions or this permit shall be deemed revoked.
.. ..
Front Setback_ from Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY
Side Street Setback from Center Line
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.)
Side Setback from Property Line
Lender's Name
Lender's Address
FINAL DATEC
SPE TO
INSPETOR
This is a building permit when properly filled out, signed and validated, and is subject to
6/24/48
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.
Issued by:
Date Permit
1 agree to comply with all city and county ordinances and state laws relating to building
i
construction, and hereby authorize representatives of this city to enter the above.
mentioned property for inspection purposes.
Validated by:
• Signature of applicant Date
Mailing Address
Validation:
'r. City, State, Zip
+ `! WHITE FINANCE, PINK -'APPLICANT, GREEN- BUILDING, GOLDENROD •55E6SOR'S OFFICE, HARD COPY - FILE � ?
S ' a
r.,, _..i i.•t.-�..... t.', .:.+r- ¢ ,:.:. 7r�+a. �... .r�:, ti..ati '.. •.,....r,.. ._:.,i.,.a�._ .....
_. ,.. _.. .. .r Gr.• ..:a..__.
� ..,... ....... ._. ._ _ .•.S
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL SO FT (p Z
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. of
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
POWER OUTLET
ROOF DRAINS
GAR SO. FT. &
TEMP. POLE
GROUT
DRAINAGE PIPING
CAR P. SO FT. @
FINAL INSP.
BOND BEAM
WATER SYSTEM
DRINKING FOUNTAIN
WALL SO. FT. /a
_$
LUMBER GR.
FINAL INSP.
URINAL
SO. FT. 0
ROOFING
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as properly tax valuation
FLOOR DRAIN
MECHANICAL FEES
VENTILATION
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTONDISH)
APPLIANCE DRYER
FIREPLACE
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
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
SO. Ff. @ c
WATER HEATER s
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID @ 14 c
SEWAGE DISPOSAL
SO.FT.GAR Q 3/,c
HOUSE SEWER
'
CERT. OCC.
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 8 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 APP./EQUIP.
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
'
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESANITIALS
,
GARDEN WALL FINAL