04643 (BLCK)04643 .
P.O. BOX 1504
..78-105 CALLE ESTADO _
Building - - -
Address"" �j.��3YiK� LA QUINTA, CALIFORNIA 92253
<,
Owner
Cherkee Homes' ' BUILDING:" TYPE CONST. OCC. GRP.,
Mailing,
Address .,79—.811 Coun'rV Club Dyl iVe A.P. Number.
City ,. Zip Tel. - ' .
3 wda Mine; 9220 3���6225 ... Legal Description ,
.. ._..
Contractor Project Description 237' garden Wall 6' h .qh
Address 7_
City'- Zip Tel.
State Lic. +_ City }
& Classlf.' 476007 t Lic. # w Sq. Ft. f No. No.
Arch., Engr.Size Stories Units +
, - _
Designer,_ New ❑ Add 0,' Alter ❑ Repair ❑ Demolition ❑
Address = " Tel.
City Zip f, State '' 4 t+
Lic. #
LICENSED CONTRACTOR'S DECLARATIONr{
I 1 he affirm that I am licensed under provisions of Chapter 9 (crf'mmencing with Section
700pjlof Division 3 of -the Business and=Professions code, and my license is in full force and 1
effect.
`SIGNATURE - -P ..d` Z., -+' 6..r'71A�.!/>" f DATE
OWffER-BUILDER DECLARATION Estimated Valuation I hereby affirm that I am exempt from the Contractor's License Law for the following S 925 _
reason: (Sec. .703 1.5. Business and Professions Code: Any city or coty which requires a
permit to construct, alter, improve, demolish, or repair any structure, .pnorNto its issuance also - -• �`
` requires the applicant for such permit to file a signed statement that he is licensed pursuant to PERMIT. •. AMQUNT°
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 apphcanf'to;a civil penalty of not more than five hundred dollars ($500).
i ' ❑ I,:asowneii:of the property, or my employees with wages as their sole compensation, will 'Plan Chk. Bal.
do the work ,arid the structure is not intended or offered for sale. (Sec. 7044, Buisness and Const. •
Professions. Coder=The' Contractor's License Law does not apply to an owner of property who
builds � or iinpioves-, thereon and who does such work himself or through his own°employees, Mech. -
pr6vided: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.) - -
O 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 r
does not apply to an owner or 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.) ,
+Grading
O 1 am exempt under Sec. B. & P.C. for this reason
i Driveway Enc. ,
Date' owner Infrastructure ?1
~ WORKERS' COMPENSATION DECLARATION'
hereby affirm that I have a certificate of co sent to elf•insure, or a certificate of
Worker's Compensation Insurance, or a certified copy thereoi(Sec:F3800, Labor Code.) ' ' , ••
Policy No. Company ✓'{""% t�� _-
O Copy is filed with the city. O Certified copy is hereby furnished.
TOTAL f)
CERTIFICATE OF EXEMPTION FROM REMARKS
r WORKERS' COMPENSATION INSURANCE
t (This section need not be completed if the permit is for one hundred dollars ($100) valuation • ,$:.lM/,;,ttp�"�n, �f �;,�,"�1E!a"fir,"''w wi`Plin�T�
-I or lel certify that in the performance of thg work for which this permit is issued, I shall not y
employ any person in any manner so as to become subject to the Workers' Compensation
Laws of California.
f
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:
comply with such provisions or this permit shall be deemed revoked. - `
Front Setback from Center Line
t 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 ofthe
•,` work for which this permit is issued. (Sec. 3097, Civil Code) " Side Setback from Property Line
,Lender'§ Name
k..
Lenders Address ' . "tr, r., K .
This is a building permit when properly filled out, signed and validated, and is subject to Y FINAL DATE INSPECTOR
`
:ryexpiration if work thereunder is suspended for 180 days., ->: • = ,�.. ' _� .kai / ,
r 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 i
y construction,�and •hereby authorize representatives -of ''this ;city to enter the above-
mentioned property for inspection purposes.. - -- 1 ' Validated by. f '
•! Signature of applicant •" ' .''4 Date •'-
Mailing Address Validation.
` City; State, Zip
WHITE FINANCE PINK APPLICANT GREEN BUILDING, GOLDENROD ASSESSORS OFFICE HARD COPY FILE
k,.....,, .:..e:.:a,t„i.�..Tti`:'..�....c.-'x<..,,w_i,'.:Lq ;L,::; `:y:..f_g ...: .-f�:v.. h._.i.:ar.. .<e:..py>:.'�...'...i2'1ia t-t�� �.,w'.is; *•.. .s �F'.,..-,-� � _. -. ....._.-
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL SO FT ( S
UNITS
SLAB GRADE
2ND FL SO F1. a
BONDING
YARD SPKLR SYSTEM
POR SO FTat
MOBILEHOME SVC.
BAR SINK
GAR SO. FT. ftt
POWER OUTLET
ROOF DRAINS
FOUND. REINF.
GAS (ROUGH)
DRAINAGE PIPING
CAR P. SO FT. rd
OTHER APP.IEOUIP.
I
WALL SO. FT. fd
TEMP. POLE
DRINKING FOUNTAIN
SO. FT. 0
GROUT
URINAL
ESTIMATED CONSTRUCTION VALUATION S
FINAL INSP.
WATER PIPING
NOTE: Not to be used as property tax valuation
WATER SYSTEM
FLOOR DRAIN
MECHANICAL FEES
=S
IWATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASH ER(AUTONDISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
REMARKS:
LAUNDRYTRAY
AIR HANDLING UNIT CFM
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
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT. B.T.U.
SO. FT. RESID a I V: c
SEWAGE DISPOSAL
SO.FT.GAR @ ;i c
HOUSE SEWER
MESH
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) /,�J �Gf_
_/
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM / IJ �� '
WATER SYSTEM
I
GRADING
cu. yd.
$ plus xS
=S
LUMBER GR.
•SINAL INSP.
FRAMING
INAL INSP. G-
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
/j FINISH GRADING r�
�14INAL INSPECTION/U-�-t/—,F
/�
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESlINITIALS
,
GARDEN WALL FINAL