12417 (BLCK)Building
Address
11111111IIIIIIIl11111 04
IE
54-700 Alvarado
4 4 a d tra
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
Owner
Doxy Hamilton
Mailing
Address
P.Q. Box 1281
City
La Qninta, C2
Z
p92253
Tel.
Contractor
East Valley Construction
Address
P.O.. Box 1281
No. 12417
BUILDING: TYPE CONST. OCC: GRP.•
A.P. Number
Legal Description
Project Description 230 4 of 5' high block wall
60' of 2' high retaining wail
City.Aaa Quinta, CC
P92253
Te6'64-4$44
State Lic.
& Classif. B-296566
City
Lic. #
Arch., Engr.,
Designer
Sq. Ft.
Size
No.
Stories
No. Dw.
Units
New D Add 0
Alter 0
Repair 0
Demolition 0
Address
Tel.
City
Zip
State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I herebyaffirm-that I arp'licensed undecpiovisions of Chapter 9 (commencing with Section
7000) of Division,of the Business and Professions Code, and my license is in full force and
effect.
SIGNATURE i Z 4" -- 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
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
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
subjects the applicant to a civil penalty of not more than live hundred dollars (8500).
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. ll, 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.)
0 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 contractor(s) licensed pursuant to the Contractor's License Law.)
0 I am exempt under Sec B & P.C. for this reason
Date Owner
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. 0 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 (8100) valuation
or less.) '
I 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: !f, after making this Certificate of Exemption you should become
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
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
Estimated Valuation
$4,979.00
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
tx.>. rrr
REMARKS
ZONE- BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side`S.treet Setback from Center Line
Side Set
FINAL DATE
.Issued by'
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO.
ELECTRICAL FEES
NO.
PLUMBING FEEst.
1ST FL.
SO. FT.
SO. FT.
SQ. FT.
SO. FT.
SO. FT.
SQ. FT.
SO. FT.
VALUATION
®
$
BONDING
HEATING (ROUGH)
UNITS
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
-
2ND FL.
0
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
YARD SPKLR SYSTEM
WATER HEATER
SERVICE
POR
®
BOND BEAM , ;47_4,3 4. 0
WATER SYSTEM
MOBILEHOME SVC.
=$
LUMBER GR — /.2 _, —$340,
'(Y
BAR SINK
$ plus x$
FRAMING
GAR.
®
ROOFING
[/)
POWER OUTLET
VENTILATION
ROOF DRAINS
FIREPLACE
CAR P.
0
SPARK ARRESTOR
GAR. FIREWALL
LATHING
DRAINAGE PIPING
INSULATION/SOUND
WALL
®
FINAL INSPECTION / 2.- 27 13
CERT. OCC.
FENCE FINAL
DRINKING FOUNTAIN
INSPECTOR'S SIGNATURES/INITIALS
GARD.EN WALL FINAL
®
URINAL
ESTIMATED CONSTRUCTION
$
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY '
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.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SO.FT.GAR ® Lac
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
PLUMBING
ELECTRICAL
HEATING & AIR COND.
SOLAR
SETBACK f0"
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
Ren
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM , ;47_4,3 4. 0
WATER SYSTEM
GRADING
cu yd
=$
LUMBER GR — /.2 _, —$340,
'(Y
FINAL INSP.
$ plus x$
FRAMING
FINAL INSP.
ROOFING
[/)
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION / 2.- 27 13
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARD.EN WALL FINAL