9858 (BLCK)•, 4
�7��II11� K/
" P.O. BOX 1504 , �
No. 9858
Building 7&105 CALLE ESTADO /
Address 53-845 VALLEJO LA QUINTA, CALIFORNIA 92253
Owner
DAVE FISHER BUILDING: TYPLONST. 13LO K ��EfC''(GRP.
Mailing
Address 53-650 DIAZ A.P. Number
City Zip Tel.
LA QUINTA, CA 92253 1564-2539 Legal Description
Contractor HELEN Project Description BLOCK WALLS 61 X 2401
CARCIA MASONRY 4' X 50'
Address
27-550 ABRIL DR
City Zip Tel.:
CATHEDRAL CIT. 92234 322-9130
State Lic. City
& Classif. 620349 Lic. # 1939 Sq. Ft. No. No. Dw.
Arch., Engr.,
Size Stories Units
Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition
Address Tel.
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed underrprovisioas of.Chapter 9 (commencing with Section
7000) of Division f3 off the Business and, professions Code; and my license is in full force a
effect. - h_ �f,�. t r 1 ' %/mile
f d
'_SIGNATURE - f 'DATE
OWNER -BUILDER DECLARATION Estimated Valuation
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
permit to construct, alter, Improve,' demolish, or repair any 'structure, prior to. 8s issuance also AMOUNT
requires the applicant for such permit to file a signed statement that he is licensed pursuant to PERMIT
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 Plan Chk. Dep.
subjects the applicant to a civil penally of not more than five hundred. dollars.($500). Plan Chk. Bal.
❑ I, 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, Bussness and Const., $90.00
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, M@CIi.
provided that such Improvements are not intended or offered for sale. If, however, the building
or improvement is sold within one year of completion, the owner -builder will havethe burden Electrical
of proving that he did not build or improve for the purpose of sale.)
O 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 not apply to an owner of property who builds or Improves thereon, and who contracts for .S.M.I. - .70
such projects with a contractors) licensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec. B. & P.C. for this reason Grading
Driveway Enc.
Date Owner Infrastructure
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. ❑ Certified copy Is hereby furnished.
TOTAL $90.70
CERTIFICATE OF EXEMPTION'FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completedif 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
employ any pperson in any manner, so as to become subject' to the workers' Compensation
La s•oP;ia:
Californ[�/
ate / /,-f # Owner C —
NOTICE JTO 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.
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, Civil 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
ZONE:
BY:Lj {'� t x 9r�)�t►. a�_. it
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
,
1ST FL. SQ. FT. ® $
UNITS
COLL. AREA
2ND FL. SQ. FT. ®
ROUGH PLUMB.
YARD SPKLR SYSTEM
POR. SD. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SQ. FT.
DUCT WORK
DRAINAGE PIPING
WALL SQ. FT.
GAS (ROUGH)
DRINKING FOUNTAIN.
SQ FT ®
HEATING (FINAL)
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GAS (FINAL)
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER HEATER
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
WATER SYSTEM
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
GRADING
cu. yd.
plus x$
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.
SQ. FT. ® c
BATH 'TUB
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1% c
SEWAGE DISPOSAL
SQ.FT.GAR @ 3/ic
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 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
Oat, 71
EMARKS:
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