12548 (BLCK)P.O. BOX 1504 N o . 12548
Building 50w315 Vista Montana 78-105 CALLE ESTADO
Address LA QUINTA, CALIFORNIA 92253
Owner
Dennis Roberts
Mailing BUILDING: TYPE CONST. OCC. GRP.
Address Same
A.P. Number
city g Qlainta Zjp 92233 Tel. 342-4029Legal Description
Cn�
%ram rBarajas assn Project Description 1055 1. f. AE 6' high garden
A9196ess913wall.
1 Lim Hall
CityZip Tela
Bermuda neat C.A 922tD1 345-3912
State LiaC-29 446'18 - City 180
& Classif. Lic. # Sq. Ft. No. No. Dw.
Arch., Engr., -
Size Stories Units
-
Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address Tel.
City,: - Zip State
LIC. #
LICENSED CONTRACTOR'S DECLARATION
.`I hereby affirm that I am licensed under provisionsTof Chapter 9 (commencing with Section
7pb0)'of. Division 3 of the Business and Profes
sions
.
ode�and my license is in full force and 7
effect.. 'ice'
SIGNATURE / - DATE
7
OWNER -BUILDER DECLARATION Estimated Valuation
I, hereby affirm that I am exempt from the Contractor's License Law for the following $26,400.00
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 Plan Chk. Dep.
subjects the applicant to a civil penalty or not more than five hundred dollars ($500). .
❑ 1, 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. 26:).00
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 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. 1.
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
Grading
❑ I am exempt under Sec. B. 8 P.C. for this reason
Driveway Enc.
Date Owner Infrastructure
r
WORKERS' COMPENSATION DECLARATION
hereby affirm that I have a certificate of consent to self -insure, "Tori
(certificate of
Worker's Comp n'sation Insurance, or a certified copy thereof. (Sec:;380t)bor Code.) 1
Policy No. Company ^5 �`�'• `
py 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 ($100) valuation
or less.)
1 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.
Date Owner
NOTICE TO APPLICANT: 8, 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
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY Side Strb6f Setback from Center Line a`
Ihereby affirm that there is a construction lending agency for the performance of the r--- s
work for which this permit is issued. (Sec. 3097, Civil Code.) - Side Setback from Property Line ;t
Lender's Name a
Lender's Address 4'
This is a building permit when properly filled out, signed and validated, and is subject to FINAL DATE
expiration it 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: a e Permit
I agree to comply with all city and county ordinances and state laws relating to building I �1I,t )_
construction, and hereby authorize representatives -of this city to enter the above-. U V !J 4 19 3
mentioned property for inspection purposes. Validated by: I 1A i ,
Signature of applicant Date t �i
Mailing Address Validation: i t
City, State, Zip
t ,
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
COLL. AREA
,
�9 Y
YARD SPKLR SYSTEM
2ND FL. SQ. FT. p
HEATING (ROUGH)
STORAGE TANK
FORMS
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
DUCT WORK
ROCK STORAGE
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
METER LOOP
HEATING (FINAL)
DRAINAGE PIPING
CAR P. SQ. FT.
GAS (FINAL)
WALL SO. FT.
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
GRADING
cu. yd.
$ plus x$
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FINAL INSP.
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
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.
SQ. FT. ® c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 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.FEECONST.
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
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADINGA 10
INAL INSPECTION//4,/01/// 7
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL