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002501 (RPL).. bA 4 64� P.O. BOX 1504 No... 002501 Building 78-105 CALLE ESTADO Address %A=RRQ Oak vVigm RJ i 1 LA QUINTA, CALIFORNIA 92253 Owner BUILDING: TYPE CONST: OCC: GRP. Mailing Address 5 OMMI y C11;b A.P. Number City Mt re:ip Tel. palm ", 92—VO36�—�� .. Legal Description Contractor Project Description a!la$l lkwha. wid tand Address.... . . City - ..Zip. , . - Tel:_ State Lic. City & Classif.�� Lic. # 328. Sq. Ft. No. No. Dw. Size Stories Units --Arch., Engr., :. Designer. New Add ❑ Alter ❑ Repair ❑ Demolition ❑ Address Tel. City Zip State L•ic: # LICENSED CONTRACTOR'S DECLARATION hereb affirm that I am licensed under provisions of Chapter 9 (commencing with Section. y 7000) of Divisioro3 of the Business and Professions Code, and my license is in full force'and effect.. /d, p d 1� f .. SIGNATURE –DATE OWNER -BUILDER DECLARATION Estimated Valuation I 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, alter, improve, demolish, or epair 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 i Division '3 of the Business and Professions, Code,` or that.he W 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 of not more than five hundred dollars ($500): ❑ I, 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. 17044, Buisness and Const. ' Professions Code: The Contractor's License Law does not: apply .to an owner of propertywho 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.I. such projects with a contractor(s) licensed pursuant -to the Contractor's License Law.) - Grading ❑ I am exempt under Sec -13. & P.C. for this reason Driveway Enc. Dale owner Infrastructure 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. . ❑ Certified copy is hereby.furnished. .. TOTAL 22.50 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.) 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 of California. Date `L Owner NOTICE TO APPLICANT. If, after making this Certificate of Exemption you should become ' ZONE: BY subject to the Workers' Compensation provisions or 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 Street Setback from Center Line - 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.) 'Side Setback from Property Line ' Lender's Name Lender's Address FINAL DATE INSPECTOR 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. Issued by: Date 7-29' Permit agree to comply with all city and county'ordinances and state laws relating to building construction, and hereby authorize representatives sof this. city to enter' the above-. mentioned property for inspection purposes'. r; Validated by: Signature of applicant ��_ r'. ?!f .i.r Date— Mailing ate Mailing Address .� J 7 Validation: City, State, Zip A6 G i 3 7 2 9 2Z 5 G Ck HARD COPY CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SQ. FT. ® $ 2ND FL. SQ. FT. POR. SQ. FT. p GAR. SQ. FT. ® CAR P. SQ. FT. WALL SQ. FT. SQ. FT. ® ESTIMATED CONSTRUCTION VALUATION $ UNITS MOBILEHOME SVC. POWER OUTLET YARD SPKLR SYSTEM BAR SINK ROOF DRAINS DRAINAGE PIPING DRINKING FOUNTAIN URINAL WATER PIPING NOTE: Not to be used as property tax valuation BONDING FLOOR DRAIN MECHANICAL FEES FORMS WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER GAS (ROUGH) GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED OTHER APP./EQUIP. LAUNDRY TRAY AIR HANDLING UNIT CFM TEMP. POLE 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. SQ. FT. ® c BATH TUB SQ. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SQ. FT. RESID ® 11/4 c SEWAGE DISPOSAL SQ.FT.GAR ® 3/aC HOUSE SEWER REMARKS: 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 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 INSULATIONISOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE .FINAL TOR'S 51GNATURE5/INITIALS, GARDEN WALL FINAL