BLCK (15101)P.O. BOX 1504 N o . 5101
Building 52-270 Navarro } 78-495 CALLE TAMPICO [
Address LA QUINTA, CALIFORNIA 92253
OwnerL1Z10:3G r
Address 72-850 Somrea
BUILDING: TYPE CONST. OCC: GRP.'
A.P. Number
City Zip Tel.
.Pa1n. Desert 192260 1 346.s-2840 Legal Description 1
ContractorProject Description ? ?,O �E+E�i4 - fo, `,moi, -h
Hamilton Masonry
,:Address
{
F0 ROX 1771
City: Zip Tela
`State Lic. CI y:; :•
Classif.. Lic.#
' Arch., Engr
Designer
Address Tel.
City Zip State
i . Lic. #
LICENSED CONTRACTOR'S DECLARATION
1 hereby affirm that Iden li ensa�d under proy(si�ns, of Chapter 9 (commencing with Section
_ .7000) ofSDyiG�isio♦n 3�of the Busln sand Prof��is'sisdns Code, and my license is In fu�l,,force apd
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractors License Law for the following
.' reason: (Sec. 7031.5,Suslness and Professions Code: ,Any city or county which requires a -
permit to construct, after, 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
Me provlslons of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
.Ofvlslon 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
subjects the applicant to a duff 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 .
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
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
or improvement is sold within one year of completion, the owner -builder will have the burden
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-
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
such projects with a contractors) #caned pursuant to the Contractor's License Law.)
O 1 am exempt under Sec �n7 B. lL P.C. for this reason —
•
' Date !� 6' (luinar
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
O Copy is filed with the city, O Certified copy is.hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed If the permit Is for one hundred dollars ($100) valuation
or less.)
I certify that in the performance of thg work for which this permit is issued, I shall not
Garden . Wall '
employ any pon ,n any manner so as to become subject to the Workers' Compensation
Laws of Cal ifeornirsa
Date Owner_ y
' "NOTICE TO APPLICANT: lf, 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 Centern�
Rear Setback from Rear PP p. Lire
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND Side Street Setback frg ter Lin
SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE
HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, Side Setback. from P. y Lin
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND
ATTORNEY'S FEES.
Ttiis is a building permit when properly'filled out, signed and validated, and is subject to FINAL DATE IiPECTOR
expiration if work thereunder is suspended for 180 days. f✓
I certify that I have read this application and state, that the above information is correct. ISSUed by:' Date -N ' Permjt
I agree to comply with all city and county ordinances and state Iaws'relating to building I n
construction, and hereby authorize representatives -of this city to enter the above.. A) j
mentioned property for Inspection purposes. Validated by: lJ'
Signature of applicant Date {
Mailing Address Validation: /
City, State, Zip
Sq. Ft.
Size
No.
Stories
No. Dw.
Units
New ❑ Add ❑
Alter ❑ .
Repair ❑ Demolition ❑
Estimated Valuation
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk.•Bal.
Const.
y
Mech.
Electrical
Plumbing-
S.M.I:
Grading
Driveway Enc.
Infrastructure
e
TOTAL
REMARKS
employ any pon ,n any manner so as to become subject to the Workers' Compensation
Laws of Cal ifeornirsa
Date Owner_ y
' "NOTICE TO APPLICANT: lf, 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 Centern�
Rear Setback from Rear PP p. Lire
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND Side Street Setback frg ter Lin
SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE
HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, Side Setback. from P. y Lin
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND
ATTORNEY'S FEES.
Ttiis is a building permit when properly'filled out, signed and validated, and is subject to FINAL DATE IiPECTOR
expiration if work thereunder is suspended for 180 days. f✓
I certify that I have read this application and state, that the above information is correct. ISSUed by:' Date -N ' Permjt
I agree to comply with all city and county ordinances and state Iaws'relating to building I n
construction, and hereby authorize representatives -of this city to enter the above.. A) j
mentioned property for Inspection purposes. Validated by: lJ'
Signature of applicant Date {
Mailing Address Validation: /
City, State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBIW FEES
1ST FL. SO. FT. ® $
UNITS
SLAB GRADE
2ND FL. SO. FT. p
'BONDING
YARD SPKLR SYSTEM
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. I SO. FT.
GAS (ROUGH)
DRAINAGE PIPING
WALL SO. FT.
OTHER APP./EQUIP.
DRINKING FOUNTAIN
SO. FT. ®
TEMP. POLE
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GROUT
WATER PIPING
NOTE: Not to be used as property tax valuation
tFINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SYSTEM
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(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, TEMIPERM
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 ® 11/4 c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ac
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./EQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
tFINAL 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
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIQNATURESlINITIALS
GARDEN WALL FINAL 71