9609 (BLCK)4,4
P.O. BOX 1504 No. 9609
Building 78-105 CALLE ESTADO
Address 44185 Goldenrod Ci-rcle LA QUINTA, CALIFORNIA 92253
Owner
Gary Thompson BUILDING: TYPE CONST. OCC,. GRP. -
Mailing
Address same A.P. Number
City ip
Legal Description
Contractor
owner/Builder Project Description
Address 150 1f of. 61 block wall
City Zip TeL
State Lic. City
& Classif. Lic. # Sq. Ft. No. No. Dw.
Arch., Engr., Size Stories Units
Designer New 0 Add 0 Alter 0 Repair El -Demolition 0
Address Tel.
City Zip State
I Uc. #
LICENSED CONTRACTOWS 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.
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 3750.00
permit to construct, alter, improve. demolish, or repair any structure, prior to its issuance also
requires the applicant for such permit to Me a signed statement ftl he 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 basi's
i oftir.the alleged exemption. Any violation of Section 7031.5 by -any applicant for a permit Plan Chk. Dep.
'subjects the applicant to a civil penafty, of not more than ffive hundred dollars ($500).
sation will Plan Chk. Bal.
I; as owner of the property, or my employees with wages as their sole compen
the work, and the structure is not intended or offered for sale. (Sec, 7044, Buisness, and Const. 63.00
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, Mech.
provided that such improvements are not intended or offered for safe. ff. however, the buildh7g
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 of sale.)
b 1, as owner of the property, am exclusively contracting with licensed contractors to corv- Plumbing
struct the project. (Sec. - 7044, Business and Professions Code: The, Contractor's License Law
does not apply to an owner of prqperty,who bugds or Improves there6n, and who contracts for S.M.I. .40 -
such projects with a contractor(s) fAcensed pursuant to the Contractor's Lic6nse Law.)
1 4 .1 Grading
0 1 am exempt under Sec -B. & P.C. for this reason
i M
Driveway Eric.
-A Infrastructure
Date __�_Owner �411' Jk/ 4"
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 I -
0 Copy is filed with the city. 0 Certified copy is hereby furnished. TOTAL 63.40
CERTIFICATE OF EXEMPTION FROM REMARKS
WORKERS'COMPENSATION INSURANCE
(This section need not be completed i&lhe permit is for one hundred dollars ($100) valuation
or less.) � JL 4 14
1 certify that in the perforrnance of;thp work for hhich this permit is issued, I shall not -63.40
=any person in any manner soaks to become subject to the Workers' Compensation
California,
4"�
Date PU Owneri,�_,,_
I "a,
NOTICE TO �PPU&NT. makiiii; this';'Cer6ficate of Exemption you should become ZONE: BY:
en,
subject to the Workers' ensation provisidiisfof the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked. Minimum Setback Distances:
Front Setback from Center Lin
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, CW Code.) Side Setback from Property Line
Lender's . Name
Lender's Address
This is a buildin� permit when properly filled out, signed and validated, and is subject to FINAL DATE —INSPECTOR
expiration it work I ereunder is suspended for 180 days. . I
I car tify 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 -of this city to enter the -above-.
mentioned property for inspection purposes. Validated by:
Signature of applicant� Date.
Maili ' ng Address Validation:
City, State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. Fr. @ $
UNITS
SLAB GRADE la
2ND FL SO. FT. @
BONDING
YARD SPKLR SYSTEM
I
POR. SO. FT. @ -
MOBILEHOME SVC.
BAR SINK
GAR. 50. FT. 0
POWER OUTLET
ROOF DRAINS
FOUND. REINF. V
GAS(ROUGH)
DRAINAGE PIPING
CAR P. SO. FT. @
OTHER APPJEOUIP.
REINF. STEEL
WALL $0. FT. @
TEMP. POLE
DRINKING FOUNTAIN.
SO. FT. @
GROUT
URINAL
ESTIMATED CONSTRUCTION VALUATION $
FINAL INSP.
WATER PIPING
NOTE: Not to be used as property tax valuation
WATER SYSTEM
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVARCOOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYEA
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
I LAUNDRYTRAY
AIR HANDLING UNIT CFM
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET
COMPRESSOR HP
POLE, TEMIPERM
LAVATORY
HEATING SYSTI�M FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER. B.T.U.
SO. FT. @ c
BATH TUB
SPARK ARRESTOR
SO. FT. @ c
WATER HEATER
MAX HEATER OUTPUT, B.T.U.
SQ. Fr. RESID g 1% c
SEWAGE DISPOSAL
LATHING
SO.FT.GAR @ V4c
HOUSE SEWER
GAS PIPING
PERM FEE
PERMIT FEE
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE ELECT.FEE
SMIFEE PLUMB. FEE
STRUCTURE / PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE la
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
I it,
SEWER OR SEPTIC TANK
ROUGH WIRING,
DUCT WORK
ROCKSTORAGE
FOUND. REINF. V
GAS(ROUGH)
METER L60P
HEATING (FINAL)
OTHER APPJEOUIP.
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
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECT R'S SIGNATURESANITIALS
GARDEN WALL FINAL