14486 (BLCK)4:
4
P.O. BOX 1504 No. 14486
78-495 CALLE
54-050 Eisenhower LA QUINTA, CALIFORNIA 902253
Owner Double D Construction
Mailing BUILDING: TYPE CONST: OCC. GRP.
Address 53-960 Ave. Herrera ,
A.P. Number
!, City Zip Tel.
La Quinta, Cs .92253 7711561 Legal Description
ContractorProject Description 2.00 1 of 41 high retaining
s3te Ira l l
7 -Address.
City Zip Tel.:
State Lic. 4 City
& Classif. 6��'91Z Lic. # 323 Sq. Ft. No. No. Dw.
Size Stories • Units
Arch., Engr.;
Designer 1 New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address I Tel.
City(Zip ( State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chap er 9 (commencing with Section
i x/7000) of Divisio 3 of the Business end Profes�sio'ns,Codee, d my license is iin}ful ford d
fie°#tii4�1640 p � / 91vt fC_,` 1.4, t ,7 6 f 1bI
SIGNATURE - DATE
j OWNEWBUILDER 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 file a signed statement that he is licensed pursuant to
the provisions of the Contractors 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 basis
for the alleged exemption. Any violation of Section 7031.5 by 'any applicant for a permit
sub/eats the applicant to a civil penalty of not more than rive hundred dollars ($500): - -
❑ I, as owner of thero
p party, 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 or property who
builds or Improves thereon and whodoes 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 -builder will have the burden
ofproving that he did not build or improve for the purpose of sale.)
❑ 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) (rcensed 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
Workers Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. Company
❑ Copy Is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
j - 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,whi h this permit is issued, I shall not
• w�employ any perso�jn in any m nnersoas�/to became s bj ct to the Workers' Compensation
Lawsyotg ifo
ate i J' Owner. S �-
NOT/CE LTO PPLICANT: B, alter making this Certlfrcate o/ Exemption you should become
• subject to the Workers' Compensation provisions o/ 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 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 applicant Date
Mall ing. Address
City, State, Zip
Estimated valuation $3,664.00
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
63.00
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
63.00
REMARKS
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center.Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line"
—Side
ine-
Side Setback from. Property Line
FINAL DATE
1
Issued by: Date_
Validated by:
'IV
CONSTRUCTION ESTIMATE NO. I ELECTRICAL FEES NO. I PLUMBI"
1ST FL. SO. FT. @ $
UNITS
UNDERGROUND
A.C. UNIT
COLL. AREA
YARD SPKLR
2ND FL. SQ. FT. @
BONDING
HEATING (ROUGH)
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
ROUGH WIRING
DUCT WORK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
METER LOOP
DRAINAGE PIPING
CAR P. SQ. FT.
REINF. STEEL -
GAS (FINAL)
WALL SQ. FT. ®
TEMP. POLE
DRINKING FOUNTAIN
SO. FT. ®
GROUT 17
URINAL
ESTIMATED CONSTRUCTION VALUATION $
SERVICE
WATER PIPING
NOTE: Not to be used as property tax valuation
BOND BEAM 9�
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
FRAMING
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
ROOFING
LAUNDRY TRAY
AIR HANDLING UNIT CFM
REMARKS:
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 ® 1 Va c
SEWAGE DISPOSAL
SQ.FT.GAR ® V4c
HOUSE SEWER
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 GOND. 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 17
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM 9�
ATER 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 SIGNATURES/INITIALS
GARDEN WALL FINAL