14457 (BLCK)Building
Address 53-795. Eiseah6wer' Dr.
Owner .Bob Wright
Address Saab •
City Zip Tel.
&a Quinta, CA 9.2253
Contractor
Fis' Milton Masonry
Ad°d.vo Bbk 1772
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
-fa Quintet CA 92253 145--7659
State Lic.591654 City 1631
& Classif. Lic. #
Arcn., Lngr.,
Designer
Address Tel.
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION.
I hereby,affirm that I am>licen/ed under, Isions of Chapter 9,(commencing with Section,.'
000) of ivisi f of th'e BuRiness and r essions Code, and my license is in full force and
tNATZ., dw-ii fr
SIGNATURP' - f f 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 which requires a
permit to construct, after, improve, demolish, or repair any structure, prior to its issuance also
.requires the applicant for such permit to rile 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 or 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
subjects the applicant to a civil penalty of not more than rive hundred dollars (5500).
❑ 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, Buisness and
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,
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•bullder will have the burden.
of proving that he did not build or improvefor the purpose of sale.) .
O 1, 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) pcensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec. B. & P.C. for this reason
Date Owner
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 Company
qff,Copy,, is filed with the city. O Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE -
(This section need not be completed ff 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, 1. shall not .
employ any person in any manner so as to become subject to the Workers' Compensation
Laws of California.
Date----:-dwner
NOTICE TO APPLICANT: ti, 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.
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND "
SHALL SUBJECT 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
ATTORNEY'S FEES.
This is a building permit when properly filled out, signed and validated, and is subject to
expiration it work thereunder is suspended for 180 days.
I car tify.that I have read this application and state that the above information is correct.
I agree tocomply 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.
i Signature of.applirant Date
Mailing Address
City, State, Zip
No. 14457
BUILDING: TYPE CONST. OCC. GRP.
A.P. Number
Legal Description
Project Description -65-1, ®f • 41 h-igh garden wall
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
Validated
Validatior
Sq. Ft.
Size
No.,
Stories
No. Dw.
Units
New ❑ Add ❑
f Alter ❑
Repair ❑ Demolition ❑
Estimated Valuation
lit 150 00
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
d 45.00
Mech' .
Electrical '
.Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
45.00
REMARKS
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
Validated
Validatior
CTION ESTIMATE I NO. I ELECTRICAL FEES I NO. I PLUMBINU FEES
SO. FT. ® $
UNITS
UNDERGROUND
YARD SPKLR SYSTEM
2ND FL. SO. FT.
SLAB GRADE
ROUGH PLUMB.
BONDING
MOBILEHOME SVC.
BAR SINK
POR SO FT ®
STORAGE TANK
FORMS
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
DUCT WORK
DRAINAGE PIPING
CAR P. I SO. FT.
GAS (ROUGH)
METER LOOP
WALL SO. Ff.
DRINKING FOUNTAIN
OTHER APP.IEOUIP.
REINF. STEEL
URINAL
SO. FT. ®
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
SERVICE
FLOOR DRAIN
MECHANICAL FEES
FINAL INSP.
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
$
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LUMBER GR.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
I
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 ® 11/4 c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/<c
HOUSE SEWER
SPARK ARRESTOR
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
/r
'/!✓ d
P/ L�
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIONATURESIINITIALS
GARDEN WALL FINAL