9589 (BLCK)Building
Address
Owner
Fidr
a 4ubd
P.O. BOX 1504 /1 6oN o .
7&105 CALLE ESTADO � �/'�
54-105 Dial LA QUINTA, CALIFORNIA 92253
& Sharon Horner
Address sante,
City Zip Tel.
La Quinta 92253 564--5450
owner
Tel.:
State Lic. City
& Classif. Lic. #
Arch., Engr.,
Designer
Address
CityI Zip I 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 1 am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Business and Professions Code: Any city Or county whidr requires a
permit to construct, after, improve, demolish, or repair any structure, prior to its issuance also
repuires the applicant for such permit to rile a signed statement that he is licensed pursuant to
the provisions of the Contractor's Ucense 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 staged exemption. Any violation of Section 7031.5 by 'any applicant for a pemd
subjects the applicant to a civil penalty of not more than five hundred dollars ($500).
❑ 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, eutsness and
Professions Code: The Contractor's License Law does not apply to an owner of property, who
builds or irproves thereon and who does such work hinself or through his own errpbyees,
provided that such improvements are not intended or offered for sale. ff. however, the buiYrg
or improvement is sold within one year of completion, the owner-butder will have the burden
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-
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
such projects with a contractor(s) licensed pursuant to the C:ntractor's License Law.)
❑ 1 am exempt under Sec. r- 1 B. & P.Ctfor
` this reason
Date OwnerV T '1T VWV 94 f 'r v %Ill Ilk .A't
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certific to elef,.00nsent to self -insure, or a certificate of
Worker's Compensation Insurance, or a certified cop thereof. (Sec. 3800, Labor Code.)
Policy No Company
O Copy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS'COMPENSATIONINSURANCE
(This section need not be completed 1/ the permit is for hundred dollars (S 100) vaMration
or less.) T
I certify that in the performance of the work 6r which this permit is issued, I shall not
employ any
Catifppeerson in an a e so as to become subject to the Workers' Compensation
Laws of omia.
Date Owner '� - n\hM�}�1
NOTICE TO APPLICANT: f, after inakirigf this Ce�cate of, Exemption you shoum become
subject to the Workers' Compensation provisions 6Y<,4he Labor Code, you must forthwith
comply with such provisions or this permit shall06 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.)
Lenders Name
Lenders Address
This is a building permit when properly filled out, signed and validated, and is subject to
expiration it work thereunderdis 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
BUILDING: TYPE CONST.
A.P. Number
,Legal Description
Project Description
60 if of 5'
OCC. GRP.-
high block wall
Sq. Ft.
Size
No. No. Dw.
Stories Units
New ❑ Add ❑
Alter ❑' Repair ❑ 'Demolition ❑
Estimated Valuation
1299.00
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
4 5 • tJ Q
Mech.
Electrical
Plumbing
S.M.I.
.21E)
Grading
Driveway Enc.
Infrastructure
TOTAL
45.2U
REMARKS
nnc.tln'?
f0 , .GAsR 1 tUTAK 1 4:� Zv
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
1ST FL. SO. FT. ® $
UNITS
A.C. UNIT
COLL. AREA
SLAB GRADE
YARD SPKLR SYSTEM
2ND FL. SQ. FT.
BONDING
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
ROUGH WIRING.
DRAINAGE PIPING
CAR P. I SQ. FT.
FOUND. REINF.
GAS (ROUGH)
WALL SO. FT.
DRINKING FOUNTAIN.
SO FT ®
HEATING (FINAL)
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GAS (FINAL)
WATER PIPING
NOTE: Not to be used as property tax valuation
TEMP. POLE
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
BOND BEAM
LAUNDRY TRAY
AIR HANDLING UNIT CFM
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET
COMPRESSOR HP
POLE, TEM/PERM
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 ® 11/a c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/4c
HOUSE SEWER
FIRE ZONE ROOFING
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
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL