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002268P.O. BOX 1504 Building 78-105 CALLE ESTADO Address KA—W= flnle %Fill LA QUINTA, CALIFORNIA 92253 Mailing Address 75-005 C=AXV CIMb Drig City JZip Tel. PAUI. %m4ext 92260 Contractor Fma Tara Address _ Sim 'City Zip Tel. State Lic. I City & Classif. Lic. # Arch:, Engr., ' Designer Address Tel. ILDI NG:. TYPE CONST. OCC: GRP P. Number Legal Description Project Description PICA WEV P=4 4 0 FbMM3A CM 1918 Sq. Ft.- 424 No. Dw. Size's Stories R. Units .2 New E&, Add ❑ Alter ❑ Repair ❑ Demolition ❑ City Zip State Lic. # - _ LICENSED CONTRACTOR'S DECLARATION .. _ I hereby affirm that I amlicensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full'force and ' effect. t ! SIGNATURE - / _! < DATE OWNER -BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractor's License Law for the following reason: -(Sec. 7031.5,Business 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. licensod pursuant to the provisions of the Contractor's License ,Law, Chapter 9 (commencing with Section 7000) of " Div'iSion 3 of the Business and Professlohs' 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 theapplicant to a civil penalty of not more than five hundred dollars' ($500).- ❑ 1, 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 - •50 .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. 1f, however;- the building or improvement is sold within one year of completion, the owner -builder will have the burden proving that he did not build or improve for the purpose of sale.) ❑ 1, 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.) .O 1 am exempt under Sec. B. & P.C. for this reason Estimated Valuation �+ - f' PERMIT - - AMOUNT = Plan Chk. Dep... - Plan Chk. Bal. - .60 Const. xlSd�s Mech.Qy 300 Electrical 74.69of Plumbing 47 �ry s50 ...' S.M.I. Grading Driveway Enc. Date Owner Infrastructure 13�tj5.9i WORKERS' COMPENSATION DECLARATION ' I hereby affirm that Ihave 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. ' TOTAL 2,891.5-6 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.) ' 1 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 of California. Date Owner NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become subject to "the Workers' Compensation provisions or 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 it 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. i Signature of applicant L. �. f f .; !/_J e . j fr ,;. , Date f 11�" `•. ' Mailing Address City, State, Zip t Pf v' HARD COPY REMARKS ZONE: BY: Minimum Setback Distances: Front. Setback from Center Line Rear Setback from Rear. Prop. Line Side Street Setback from Center Line Side Setback from Property Line FINAL DATE INSPECTOR Issued -by: Date 4 00 86Permit Validated by: Validation: A'5171 4 10 X591,56 CK CONSTRUCTION ESTIMATEr NO. ELECTRICAL EES,—`— NO. PLUMBING FEES IST FL. SO. FT. ® $ •. UNITS COLL. AREA 2ND FL. SO. FT. ® vV YARD SPKLR SYSTEM POR. SO. FT. ® MOBILEHOME SVC. BAR SINK GAR. SO. FT. ® POWER OUTLET ROOF DRAINS CAR P. S0. FT. DUCT WORK DRAINAGE PIPING WALL SO. FT. DRINKING FOUNTAIN SO FT ® HEATING (FINAL) URINAL ESTIMATED CONSTRUCTION VALUATION $ 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 GRADING cu. yd. $ plus x$ 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 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 kOUND PLUMBIN UNDERGROUND A.C. UNIT COLL. AREA B GRADE �� vV A&UGH PLUMB.?� BONDING HEATING (ROUGH) STORAGE TANK FORMS IA ER ORS I GH WIRING / r I DUCT WORK ROCK STORAGE &OUND. REINF. geAS (ROUGH) 7� � N4 METER LOOP HEATING (FINAL) OTHER APPJEOUIP. 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�f si/, vv FINAL INSP. ROOFING � �� VENTILATION REMARKS: FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING ESH ULATIONISOUND GY //FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURES/INITIALS GARDEN WALL FINAL M1-y4'�/ ���c5Fj