07873 (BLCK)Building
Address
Owner
Mailing
Address
City
Address
City
State Lic.
& Classif.
Arch., Engr., .
Designer:
Address
78-685 Via Herodia
Carter
=ZIP TeL
Zip
P.O. BOX 1504 1110. V 10 1 13
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number 1.
Legal Description
Project Description 691' X 6' h1tick wall
t,Ity
Lic. # Sq. Ft. No. No. Dw.
Size . Stories Units
Tel.
City. Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under. provisions of Chapter g (commencing with Section
7000) of Division 3 of.theBusiness and P'iofessions' Code' and my license is,in full force and
effect. t`�
SIGNATURE >"'.�' '� _ "' DATE
OWNER -BUILDER DECLARATION,
I hereby affirm that I am exempt from the Contractors License Law .for the following
reason: (Sec. 7031.5,Business and Professions .Code: Any city or county which requires a
I New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
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
Plan Chk. Dep.
subjects the applicant to a civil penalty of not more than five hundred dollars ($500).!
Plan Chk. Bal.'
❑ 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
Const.'
Professions Code: The Contractor's License. Law does not apply to an owner of property.,who
builds of 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
Electrical'
'
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.
j[
such projects with acontractor(s) licensed pursuant to the Contractor's License Law.), -
"
Grading
0 I am exempt under Sec. B. ti. P.C. for this reason
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
❑ Copy Is filed with the city. ❑ Certified copy is hereby furnished.
TOTAL
CERTIFICATE OF EXEMPTION FROM
REMARKS
WORKERS' COMPENSATION INSURANCE r
(This section need not be completed if the permit is for one hundred dollars ($100) valuation
`;,Fhil.2ycU'�R'�i'�rD��`h'f-�iyx Am AA`D
or less.)
A Wu.,.., ., , • _. _._- ,�. .. ,, ... ,
certify that'in the performance of the 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.
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 .
comply with such provisions or this permit shall be deemed revoked.
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY
SIde.Street Setback from Center Line
Ihereby affirm that there is a construction lending agency for the performance of the
work for whicK 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.
5!n A�
I certify that I have read this application and state that the above information is correct.
Issued by:
7 7V Permit
Date
1 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
CONSTRUCTION ESTIMATE
$ NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
2ND FL. SQ. FT.
POR. SO. FT. ®
GAR. SO. FT. ®
CAR P. SQ. FT.
WALL SQ. FT. ®
SQ FT ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN.
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
ROUGH PLUMB.
FLOOR DRAIN.
MECHANICAL FEES
HEATING (ROUGH)
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
VJASHER(AUTO)(DISH)
APPLIANCE DRYER
DUCT WORK
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
GAS (ROUGH)
LAUNDRY TRAY
AIR HANDLING UNIT CFM
HEATING (FINAL)
I IKITCHEN 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.
SQ. FT. ® c
BATH TUB
BOND BEAM
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
LUMBER GR.
SO.FT.GAR ® V4c
HOUSE, SEWER
FRAMING
FINAL INSP.
GAS PIPING
PERMIT FEE
MIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE EPL.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 APPJEQUIP.
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�i�l
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REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL