14965 (BLCK)4
P.O. BOX 1504
Building 78-495 CALLE TAMPICO
Address 2"sit 26152' LA QUINTA, CALIFORNIA 92253
1 C:.!ntury Homi:�s Con-atitunitier;=
Mailing I '
Address; 1535 South 0u," Street
City Zip Tel.
;San 'Re�cnardinil, CA 92408 (909) 381-600 ,
Contractor
S ame
Address
Zip I Tel.
State Lic. City
& Classif. B 314473 Lic. # 2120
Arch., Engr., Designer Frank Gonzalez, & A.ssaCiate s
0411,
Al 3T6 East Chapman Ave. Te1(714) 532-687
City Zip State
Orange, CA 92666 Lic.#
LICENSED CONTRACTOR'S DECLARATION
II hereby affirm that I am licensed under provislons of Chapter 9 (commencing with Section
700p) of Division 3 of the Business and Protessjpfrs Code, and mli se Is in full force and
K.
effect _ ] f`
SIGNAT118)`_I DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt From the Contractors License Low for the fallowing
reasom (Sec. 7031.5.Busvress and Professions Code: Any Iffy or county which tagrere5 a
perm![ to conslrucf, agar, improve, demolish, or repair any structure, prier to Ifs issuance also
repuires the applicant for such permit to foe a signed statement that he is licensed pursuant to
the provisions of the ConbuOor's License Law, chapter 9 (commencing with SecNotr 7000) of
t7lvision 3 of the Business and Prolessklns Coda, or (her he is excvmpt therefrom, and the basis
for the alleged exemption. Any v)alation of Section 7031.5 by any appFlcanf for a permrl
subjects the app7icanf to a civil panatly of not main than live hundred dollars ($500J
Cl 1, as owner of the property. Cr my employees with wages as their sale compensation, will
do the work, and the structure is not intended or offered for Sale. (Sec. 7044, Bussness and
Professions Code- The Contractor's License Law does not apply to an owner of property who
[wilds or Improves thereon and who does such work himself or through his own employees,
provided that such Improvements are not latanded or offered for safe. IF, howovor, the budding
or improvemant is sold within one year of complelrnn, the owner -builder wx have the burden
of proving that he did not !wild or improve for the purpose of sale.)
❑ 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.)
❑ 1 am exempt under Sec-B. & P.C: for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
I herebyAfflrm that I have a Certificate a1 consent to self -insure, or a certificate of
Worker's pensation Insurance, aracertified copy thereof. (Sec. 3800, Labor Code.)
Policy Company
opy is filed with the city- ❑ 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 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 W Cal itorn
Date Owner _
M017CE TO APPLICANT, It, after making this Certificate of Exemption you should become
subject to the Workers' Compensallon provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND
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,
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND
ATTORNEYS FEES.
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
BUILDING: TYPE CONST
P. Number
Legal Description
No. 14965
OCC. GRP
Project Description
220 1.f. GyL' ail h aroto II
garden wall and 118' 1, f. of 11 high
retaining plan-cer walls
Walls will b lccaited at the corner of
Sq. Ft. No.
Size Stories
New ❑ Add ❑ Alter ❑
estimated Valuation $5 r 50() • 100
No. Dw.
Units
Repair ❑ Demolition ❑
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
81 00
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
I
TOTAL
$1 0 0
HLMARKS
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line_
Rear Setback from Rear Prop. Lii
Side Street Setback from Center
Side Setback from Property Line
FINAL DA
INSPECTOR
Issued by: Date PpLMiL
Validated by: 1 I AL
Validation:
i
1ST FL
2ND FL.
POR.
GAR.
CAR P
WALL
ESTIM/
NOTE:
VENT SYE
APPLIAN(
FURNACE
AIR HANC
ABSORPT
COMPRES
HEATING
BOILER
MAX. HEA
PERMIT F
DBL
CONSTRUCTION ESTIMATE
NO.
ELECTRICAL FEES
NO.
PLUMBINU FEES
SQ. FT. g
UNITS
a
YARD SPKLR SYSTEM
SQ. FT.
P
MOBILEHOME SVC.
BAR SINK
SO. FT. 0
POWER OUTLET
ROOF DRAINS
SO FT. @
DRAINAGE PIPING
SO. FT.
SO. FT.
DRINKING FOUNTAIN
URINAL
SO FT.
TED CONSTRUCTION VALUATION $
WATER PIPING
dot to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
TEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
E DRYER
GARBAGE DISPOSAL
UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
LING UNIT GFM
KITCHEN SINK
ON SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET
POLE, TEMIPERM
LAVATORY
3OR HP
SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
B.T_U.
SO. FT. ®c
BATH TUB
SQ. FT. ®c
I WATER HEATER
TER OUTPUT, B.T.U.
SQ. FT. RESID ®1V, c
SEWAGE DISPOSAL
SQ.FT.GAR ® V4c
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
_E
TOTAL FEES
MICRO FEE
MECH.FEE
PL.CK.FEE
CONST. FEE
ELECT. FEE
SMi FEE
PLUMB. FEE
STRUCTURE
SETBACK
SLAB GRADE
FORMS
FOUND. REINF
REINF. STEEL
GROUT
BOND BEAM
LUMBER GR.
FRAMING
ROOFING
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION/j
CERT. OCC.
FENCE FINAL
Xll
PLUMBING
GROUND PLUMBING
ROUGH PLUMB,
SEWER OR SEPTIC TANK
GAS (ROUGH)
GAS (FINAL)
WATER HEATER
WATER SYSTEM
FINAL INSP.
ELECTRICAL
UNDERGROUND
BONDING
ROUGH WIRING
METER LOOP
TEMP, POLE
SERVICE
HEATING & AIR COND.
A.C. UNIT
HEATING (ROUGH)
DUCT WORK
HEATING (FINAL)
FINAL INSP.
SOLAR
COLL. AREA
STORAGE TANK
ROCKSTORAGE
OTHER APP./EQUIP.
GRADING
FINAL INSP. cu. yd.
$ plus x$ _$
REMARKS:
GARDEN WALL FINAL