11872 (BLCK)P.O. BOX 1504N 11872
Building 47--:385 AVIA CORDOVA 78-105 CALLE ESTADO
Address LA QUINTA, CALIFORNIA 92253
LLOYD CAMPBELL
Mailing
Address 1390 Avlg�--. HONTS VISTA
'City - • Zip.. Tel.
PAL3°I'SPRINGS . 92262 _ 1.32502866
Contractor
.ARTISTIC MASONRY
Address
74-360 ASTIR DR`
City . I . lZip Tel.'
BUILDING: TYPE CONST. • OCC. GRP. -
A. P. Number
Legal Description*
Project Description I BLOCK WALL 50 tr X • 4'
_'BLOCS 'BALL — 60'-.K.- A.s
State LlcCity
& Classif,!,' M1 . 236192 Lic. # X556 {Sq. Ft. No..
'Stories.
Arch. Engr., ^- .
Size
Designer New ❑ Add ❑ `
Address Tel.
t a . t y: r `t • .
City Zip' State
^ i Lic. #
LICENSED CONTRACTOR'S 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. 4.
SIGNATURE _- - DATE '
. OWNER -BUILDER DECLARATION, i' Estimated Valuation '
I hereby affirm that I am exempt from•the Contractor's License Law for the following r $4, 380
reason: '(Sec 7031 5 Business and Professions Code: Any city orcounty which requires a
-a "t
No. Dwv
Units, y'-
Alter ❑ Repair ❑
• 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
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
.. r
Plan Chk' Dep. '
subjects the applicant to a civil penalty of not more than five hundred dollars ($500).
❑ I, as owner of the property, or my employees with wages as their sole compensation, will ,
, . Plan •Chk. Bal. -
Const. "
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
Mech. -- -
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 -
Electrical -
orImprovement is sold' within one year of completion, the owner -builder will have the burden
of proving that he did not build orimprove for the purpose of sale.) '
Plumbing
❑ I, as owner of the properly, 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
.S.M.I.
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)-
❑ I am exempt under Sec. B. 8 P.C. for this reason
_
Grading
Driveway Enc.
Date Owner
Infrastructure
.f
WORKERS' COMPENSATION DECLARATION .
' I hereby affirm that I have a certificate of consent to self -insure, or a certificate of
Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
,/Worker's
Policy No. Company .
Kopy is filed with the city. ❑ Certified copy is hereby furnished.
TOTAL
-Demolition ❑
CERTIFICATE OF EXEMPTION FROMREMARKS z
WORKERS' COMPENSATION INSURANCE
(This section.need not be completed if the* permit is for one hundred dollars ($100) valuation '` - ,pcasc'ttp d-�.1'`r:'i.t i� "='i "„ii�"i flt^i.. itj.` ..• `�_'" S'` t,J `�
or less.) - a, yJ ^• •'$atdu$h� �; .. if1 Z FiG_ .l-. - . ' ! :4...i?F
certify that in the performance of thg work for which this permit is issued, I shall not _ t.
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 ZONE: BY:
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith Minimum Setback Distances: f
comply with such provisions or this permit shall be deemed revoked. - -
Front Setback from Center Line
Re r Set- k f om R P L' '
CONSTRUCTION LENDING AGENCY
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.)
Lender's Name
Lender's Address
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
Mailing Address
City,, State; Zip
• 1 _
a ac r ear rop. , Ine
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE INSPECTOR
Issued by: Date + Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FE'LPJ ,
1ST FL. SO. FT. ® $
UNITS
SLAB GRADE
n ~
BONDING
YARD SPKLR SYSTEM
2ND FL. SQ. FT.
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
GAS (ROUGH)
METER LOOP
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
GAS (FINAL)
TEMP. POLE
DRAINAGE PIPING
CAR P. I SQ. FT. ®
GROUT
WATER HEATER
WALL SQ. FT. ®
FINAL INSP.
DRINKING FOUNTAIN
BOND BEAM L 7 —" /
WATER SYSTEM
URINAL
SQ. FT. ®
_$
LUMBER GR.
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.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
VENTILATION
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
FIRE ZONE ROOFING
LAUNDRYTRAY
AIR HANDLING UNIT CFM
FIREPLACE
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.
SQ. FT. ® c
BATH TUB
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.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 �LUMBING ELECTRICAL HEATING & AIR COND. SOLAR
srrr�
SETBACK /rAVGROUND
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./EQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM L 7 —" /
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
_$
LUMBER GR.
FINAL INSP. .
FRAMING
FINAL INSP.
ROOFING
1
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION 3 3
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL