003763 (BLCK)A' . .
P.O. BOX 1504 No, 003763
Building 78-105 CALLE ESTADO
Address 54--455 Eisenhwer LA QUINTA, CALIFORNIA 92253
Owner _
Western American Const.r ion Co.
Mailing - BUILDING'- TYPE CONST. OCC: GRP.
Address P. O.- Box 1379 A.P. Number 774-252-Q 3
City Zip Tel. _
, ta, . _ 22 3 $ 4 7411 , - Legal Description
Contractor Project, Description- 25 X 21 .,High retaining $l
n,ary Ravrtold
Address ..
City ' Zip Tel:
State Lic. City
& Classif. 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�am licensed under provisions of Chapter 9 (commencing with Section s
7000) of Division 3 of the Business and•Professions Code, and my license is in full force and
effect.
SIGNATURE - -r""/•✓ ,/ -\ DATE -
f
OWNER -BUILDER DECLARATION . /
I hereby affirm that I am exempt from the Contractor's License Law for the following' Estimated Valuation $375.00
reason: (Sec. 7031.,5,Business. and Professions Code: Any city or county- which requires a
permit to construct, alter, 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 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 basis
for the alleged exemption. Any violation of Section 7031.5 by 'any applicant for a permit Plat> Chk. Dep.. ••
subjects the applicant to a civil penalty of not more than five hundred.dollars ($500). -
O 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 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 sale. If, however, 'the, building
or improvement is sold within one year of completion, the owner -builder will have the. burden EIBCtfICal
of proving 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- 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. - - .50
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
❑ I am exempt under Sec. B. & P.C. for this reason Grading
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, or a certified copy thereof. (Sec. 3800, Labor Code.) -
Policy No. Company
a Copy is filed with the city. . ❑ Certified copy is hereby furnished.
TOTAL
CERTIFICATE OF EXEMPTION FROM REMARKS
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($1'00) valuation
or less.) -
I certify that in the performance of thg 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. 9535_U—M-88 13
Date Owner ,1, V twPhil 1 X 10 Y 0"
NOTICE TO APPLICANT: If, alter making this Certificate of Exemption you should become ZONE: BY:
subject to the Workers' Compensation provisions of the Labor Code; you must forthwith Minimum Setback Distances:'
comply with such provisions or this permit shall be deemed revoked. .
Front Setback from Center Line
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, 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. 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 FEES
A.C. UNIT
COLL. AREA
r' 1
1ST FL. SO. FT. ® $
UNITS
HEATING (ROUGH)
STORAGE TANK
FORMSWER
YARD SPKLR SYSTEM
2ND FL. SO. FT.
DUCT WORK
ROCK STORAGE
FO N INF. 1.
1
MOBILEHOME SVC.
BAR SINK
POR. Sp. FT. ®
OTHER APPJEOUIP.
REINF. STEEL
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
GROUT
DRAINAGE PIPING
CAR P. S0. FT. ®
FINAL INSP.
WALL SO. FT.
ATER SYSTEM
DRINKING FOUNTAIN
SO. FT. ®
_$
URINAL
ESTIMATED CONSTRUCTION VALUATION $
FINAL INSP.
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN ' EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
FIRE ZONE ROOFING
LAUNDRY TRAY
AIR HANDLING UNIT CFM
FIREPLACE
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
MESH
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1Ya c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ac
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 COND. SOLAR
SETBACK
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMSWER
OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FO N INF. 1.
1
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
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
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS.
GARDEN WALL FINAL