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003455 (ELEC)Building Address Owner 4 P.O. BOX 1504 No. .�, 78-105 CALLE ESTADO 55 55--.359 OAK RILL LA QUINTA,.CALIFORNIA 92253 Mal Ing Address 75-005 COUNTRY CLUB D1R City Zip T el. P DES 9226 .5"-6716 Contractor FTA'1' NAT TAND APS MORTCOAGE Address BUILDING: TYPE CONST.• OCC:.GRP. A.P. Number PGA V.TST Legal Description Project Description PX 5C OMM14 AM - neeMu�3ra aasein.swws a.m f. _ .. ♦ - City Zip' Tela State Lic. City ' I hereby affirm that I have a certificate of consent to self-insure,'or'a certificate of & Classif.. .288130 Lic. # 328 Sq. Ft. No. No. Dw. Policy No. —'Company Size Stories Units ,Arch., Engr.,.. Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Address Tel. _ CERTIFICATE OF EXEMPTION FROM. WORKERS' COMPENSATION. INSURANCE REMARKS City Zip State or -less.) Lic. # - 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. . LICENSED CONTRACTOR'S DECLARATION - — - .} _ 9S;M :`� 7 �� j -•. li hereby affirm that I am licensed 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. !fJ ''�' I �!f .. .. .. .. SIGNATURE / rY ..! . .:. ��ii�/'Pi..v O'.", •_ •!� . T J Y/< DATE 1_r — . oWNEA-BUILDER DECLARATION ' . I hereby affirm that I am exempt from the Contractor's License Law for the following Estimated Valuation . subject to the Workers' Cmpensation provisions of�the Labor Code, you must" forthwith. comply with such provisions or this permit shall be deemed revoked. . reason: (Sec. 7031.5,Busfness and Professions Code: Any -city or. countywhich 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 or 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 703 1. 5 by 'any applicant for a permit -'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 - - PERMIT - '• AMOUNT - Plan-Chk..Dep. , Plan Chk. Bat. CONSTRUCTION LENDING AGENCY Const. ' 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 Mech. Side Setback from Property Line 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 Electrical -` nQ or improvement is sold within one year of completion, the owner -builder will have. the burden or proving that he did not build or improve for the purpose of sale.) .. Plumbing expiration if work thereunder is suspended for 180 days. 1 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 in purposes. ❑ 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 S.M:I. . such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) 0.1 am exempt under Sec. B. & P.C. for this reason - Grading Validation: Driveway Enc. City, State, Zip Date 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 _ CERTIFICATE OF EXEMPTION FROM. WORKERS' COMPENSATION. INSURANCE REMARKS (This section need not be completed if the permit is for one hundred dollars ($100) - valuation or -less.) 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. .ai.t: A r, t A e\ -zz •7Y i A_ : ci_.. 0-i f s f — - .} _ 9S;M :`� 7 �� j -•. li Date Owner'" - NOTICE TO APPLICANT. coafter making this Certificate of Exemption you should become ZONE: BY: subject to the Workers' Cmpensation 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.Center .Line Rear Setback from Rear Prop. Line CONSTRUCTION LENDING AGENCY Side Street Setback from Center Line I hereby affirm that thele 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 FINAL DATE INSPECTOR 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. 1 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 in purposes. Issued by: Validated by: Date 10116/87 Permit' . . Signature of applicant Date " Mailing Address Validation: City, State, Zip HARD COPY CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SQ. FT. ® $ UNITS SLAB GRADE 2ND FL. SQ. FT. BONDING YARD SPKLR SYSTEM POR. SO. FT. ® MOBILEHOME SVC. BAR SINK GAR. SQ. FT. ® POWER OUTLET ROOF DRAINS CAR P. SQ. FT. GAS (ROUGH) DRAINAGE PIPING WALL SQ. Fr. OTHER APPJEQUIP. DRINKING FOUNTAIN SQ. FT. ® TEMP. POLE URINAL ESTIMATED CONSTRUCTION VALUATION $ GROUT WATER PIPING NOTE: Not to be used as property tax valuation FINAL INSP. FLOOR DRAIN MECHANICAL FEES WATER SYSTEM WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER FINAL INSP. 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,TEMIPERM LAVATORY HEATING SYSTEM FORCED GRAVITY AMPERES SERV ENT SHOWER BOILER B.T.U. SQ. FT. ® c BATH TUB SO. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SQ. FT. RESID ® 11/4 c SEWAGE DISPOSAL GAR. FIREWALL SQ.FT.GAR ® 3/ac HOUSE SEWER LATHING GAS PIPING PERMIT FEE MIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEE MECH.FEE PL.CK.FEEPER 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 APPJEQUIP. 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 INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL