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15080 (BLCK)P.O. BOX 1504 N o . 15080 Building 78-495 CALLE TAMPICO Address .54-82() ASi13)t3ida Err' ale in LA QUINTA, CALIFORNIA 92253 Owner David Miller Mailing BUILDING: TYPE CONST. OCC: GRP: Address P.O..Box 722 A.P. Number .City Zip Tel. . La Quinta 92253 564_0273 Legal Description Contractor Project Description 150 -If of 321 retaining wall sarne. ZSt91 GE 5' cra den wall. Address - :• City. Zip. Tel.: State Lic. City ; & Classif.. 5425381 Lic. # 1955 Sq. Ft. No.,'.. No. Dw. Size Stories- - Units • Designer New ❑ Add ❑ - Alter ❑ Repair ❑ Demolition,O Address Tel. City Zip State .. r Lic. # � .LICENSED CONTRACTOR'S DECLARATION I hereby a. irm that I am Ilc nsed under provisions of Chaptarq (commencing w Secf on 7000) of D[v`ision 3 of th'e Bu�stiinessf�and Profession' ode, and my license is in full olrcie`�yd r•,'. effect. • � \ � ��J \1� . .. �� SIGNATUREDATE OWNER -BUILDER DECLARATION Estimated Valuation I hereby affirm that I am exempt from the Contractor's License Law.for the following 5'�'�� •� reasom.,(sec. •7031.5,Business and Professions Code: Any city or county which requires a - permit to construct„ after, improve, demolish, or repair any structure, prior to Its issuance also - • H requires the applicant forsuchpermit to rile a signed statement that be is licensed pursuant to - .PERMIT' AMOUNT 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 penalty of not more than rive hundred dollars ($500). • O I, as owner of the property, or my employees with wages as their sole compensation, will Plan Chk. Bal. do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and Const. • _: 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 '''I � � . or Improvement is sold within one year of completion, the owner -builder will have the. burden Electrical ' of proving that he did not build or knprove for the purpose of sale.). , ❑ 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. 1. + such projects with a contractor(s) (sensed pursuant to the Contractor's License Law.), p Grading ❑ •1 am exempt under Sec- B. & P.C. for this reason Driveway Enc. Date Owner Infrastructure WORKERS' COMPENSATION DECLARATION 1 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 d ti ❑ Copy is filed with the city. ❑ Certified copy is hereby furnished. - TOTAL bi • UU CERTIFICATE OF EXEMPTION FROM REMARKS WORKERS' COMPENSATION INSURANCE (This section need not be completed If the permit is for one hundred dollars ($100) valuation i 1113` or less.) - 1 certify that in the performance of thg work for which. this permit is issued, I shall not I employ any psn in any manner so as to become subject. to the Workers' Compensation Laws of Califj ( ^ r� R ( I�� orerna- r io Date Owner NOTICE TO APPLICANT: N, after making this Certificate of Exemption you should become ZONE: -=' BY: subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions orrnls permit shall be deemed revoked.` MIi11 n1Um Setback Distan��! - R\J _.orrom Center Line <Rear Setback from Rear Prop. Line WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND { .� SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE Slf:e Street Setback from Center Line HUNDRED THOUSAND DOLLARS.($100,000), IN ADDITION TO THE COST OF COMPENSATION, Side Setback from Property Line DAMAGES AS PROVIDED FOR IN SECTION 3706' OF THE LABOR CODE; INTEREST, AND ATTORNEYS FEES. FINAL DATE INSPECTOR This is a building permit when properly filled out, signed and validated, and is -subject to. expiration if work thereunder is suspended for 160 days. 1 certify that I have read this application and, state that the above information is correct. Issued by: Date Permit 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: " Validated by: Signature of applicant Date Mailing Address Validation: City, State, Zip CONSTRUCTION ESTIMATE NO! ELECTRICAL FEES NO. PLUMBING; FEES 1ST FL. SO. 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 ROOF DRAINS GAS (FINAL) TEMP. POLE DRAINAGE PIPING CAR P. SO. FT. ® GROUT WATER HEATER WALL S0. FT. FINAL INSP. DRINKING FOUNTAIN. SO. 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 SUSPFENDED 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. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® I IA 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 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.IEOUIP. 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 INSULATION/SOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIONATUR£SIINITIALS GARDEN WALL FINAL