14683 (BLCK)a t
' 444
P.O. BOX 1504 No.
Building 78-495 CALLE TAMPICO
Address 53-160 A* +e. Villa_ LA QUINTA, CALIFORNIA 92253 x
Owner
Fuca. is ' r"aoi gage Exchange
Mailing 707-EWY� BUILDING: -TYPE CONST: OCC: GRP.
Address
A.P. Number
City Zip ]Tel.
Ranc1'st> 1 Arag�, C 92270 324-8585 Legal Description
Contractor, Project Description '
nc, 401of 41 -high -block garden wall
a�qddress,
City Zip Tel.'
Pa m SPringw,, A 92264 -(619) 323m022(
State Lic. City
& Classif.. B -700.1,97 Lic. # Sq. Ft. No. No. Dw.
Size • Stories .Units
Arch., Engr.; - . •
' Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address Tel.
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION ' .
�I hereby affirm that I amslicensed� ri�erjllrovisions of Chapter 9 (commencing with Section
000) of Division 3 of th`e:Busines's d rofessions ode, and my license is in full force and '
ffect.
$1GNATURE ✓ 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 `Y
permitto construct, after, improve, demolish, or repair any, structure, prior to .its issuance also - •�
requirestheapplicant for such permit to file a signed statement that he is licensed pursuant to - PERMIT - AMOUNT,
the provisions o!. the Contractor's License law, Chapter 9 (commencing with Section 7000) or - -
Divisfori 3 or the Business and Professkms Code; or that. he is exempt therefrom, and .thw basisI -
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 five hundred dollars ($500). '
❑ 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 oL property who . 25� Div
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
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 improve for the purpose or sale.)
O 1, 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.
such projects with a contractors) #tensed pursuant to the Contractor's License Law.) -
Grading
❑ 1 am exempt under Sec B. & P.C. for this reason
,. 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, ora certified copy thereof. (Sec. 3800, Labor Code.)
Policy No: Company '
n rnnv is fuan ,.,lth the city, ❑ Certified copy is hereby furnish -M
CERTIFICATE OF EXEMPTION FROM
WORKERS'COMPENSATIONANSURANCE'
(This section need ..not be completed iffthe permit is'!or one, hundred dollars ($100) valuation
or less.) ll
I certify that in the pert. n . thg workf r which this permit is issued, l shall not
employ anyersori`any ma`nncome subject to the'Workers' Compensation '
aws,of da tt1'�fornla. d!
aie7" Owner .
NOTICE �//`TO Aj0 PPUCANT: ff. 'after' ma)ring' this Certificate of Exemption you should become. -
subid0 to the Workers' C6mpensa8on provisions of the .Labor Code; you must"forthwith
comply with such provisions or this permit shall be deemed revoked.
WARNING: FAILURE TO SECURE' WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND
SHALL SOBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE
HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION,
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE: INTEREST, -AND.
ATTORNEYS FEES.
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 applicapt"D Date
Mailing Address.
City, State, Zip
TOTAL z!) . Liu.
REMARKS CVMD 1G Ct.en.. cont.. on ' iob
ZONE:
BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line \
Side Street Setback from .Cent�One�
Side Setback from Property'L• ine
FINAL .DAT EINSPEC�,T.OR
Issued by-
Date Per iit+o� ZX
Validated by:i
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMB i.
IST FL. SQ. FT. ® $
UNITS
SLAB GRADE
2ND FL. SQ. FT.
BONDING
YARD SPKLR SYSTEM
POR. SO. FT. @
MOBILEHOME SVC.
BAR SINK
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SQ. FT. ®
GAS (ROUGH) •
DRAINAGE PIPING
WALL SQ. FT.
OTHER APPJEOUIP.
DRINKING FOUNTAIN
SQ. FT. ®
TEMP. POLE
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GROUT
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SYSTEM
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FINAL INSP.
GARBAGE DISPOSAL
FURNACE UNIT WALL. FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
A„��M �V��
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
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1% c
SEWAGE DISPOSAL
GAR. FIREWALL
SO.FT.GAR ® 3/.c
HOUSE SEWER
LATHING
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 APPJEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM t�
J
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
_$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
/_ �i
A„��M �V��
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL