003761 (BLCK)Building
Address 79-885 Fiesta
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
Mailing
Address SaM
City Zip Tel.
%a Quinta 92253. . -
Contractor
. .ihMI&IC/St Brier
Address
City
Zip
Tel.
State Lic.
& Classif.
City
Lic. #
Arch., Engr.,'
Designer
Address
Tel.
City Zip State
- Lic. #
LICENSED CONTRACTOR'S DECLARATION _
I hereby affirm that lam 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 whit requires a
permit to construct, atter, improve, demolish, or repair any structure, prior to its issuance also
requires the applicant for such permit to file a signed statement that he is,.licensed pursuant to
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 lherefroin, - and the -basis
for the alleged exemption. Any violation of Section 7031.5 by 'any 'applicant 'for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars'($500): -
Q 1, 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, Buisness.and
Professions Code: The Contractor's License Law does not apply to an owner of property who
builds or improves thereon anh d who does such himself or through his own employees,
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
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 Contractor's License Law.) -
❑ 1 am exempt under.Sec. - B. & P.C. for this reason
'
�
_Date 2 J ' Owner
WORKERS' COMPENSATION DECLARATION
Ihereby 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. 0 Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed*if 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 person -in any manner so as to become subject to the Workers' Compensation
Laws of California.
Date Owner —'
NOTICE TO 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.
No. 003761
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number 617-113--0.08
Legal Description
Project Description 61 high 7 120" long block wall
REMARKS
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
r
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY
Sq. Ft. No.
Size- Stories
No. Dw.
Units
New ❑ Add ❑ Alter ❑
Repair ❑ Demolition ❑
work for which this permit is issued. (Sec. 3097, Civil Code.)
Side.Setback from Property Line
Lender's Name
Lender's Address
`FINAL DATE
INSPECTOR
Estimated Valuation
PERMIT' ' '
t ,
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Issued by:
*Const.
;44.5u
Mech.
Electrical
Plumbing
mentioned property for inspection purposes.
S.M.I.
.50 -
Grading
Driveway Enc.
Mailing Address _
Infrastructure
TOTAL
REMARKS
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
r
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 DATE
INSPECTOR
' This is a building permit when properly filled out, signed and validated,'andds�subject to
- -
expiration it work thereunder is suspended for 180 days.3/31/8-8
I certify that 1 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 of this city to enter the above-.
mentioned property for inspection purposes.
Validated by:
Signature of applicant Date .
Mailing Address _
Validation:
City, State, Zip
HARD COPY
T
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING F.F.ES
IST FL.S0. 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
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
FIRE ZONE ROOFING
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
LATHING
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 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.
CEINF. STEEL ( /- �- v �
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
OND 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
I N SU LATIONISOUN D
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
1 SPECTOR'S SIGNATURESIINITIALS,
V/—GARDEN WALL FINAL,66/-