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06158 (SATT)4'4 Q P.O. BOX 1504 N o . Building 78-105 CALLE ESTADO Address 55-523 0& Bin LA QUINTA,.C4IFO9NIA,92253 Owner t2tYY$ � Mailing BUILDING:- TYPE CONST. - OCC: GRP. Address 42-500 Cook St., Suite 200PGA. West • A.P. Number' - City Zip I Tel. . Palm Desert 1 022W Contractor Uational Hortaage & Land State Lic. City & Classif. 288130 Lic. # 398 - • . Arch., Engr., Designer Address Tel. City I Zip ( State Lic. # LICENSED CONTRACTOR'S DECLARATION 1 hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and,P.rofessions Code, and my.li_cense is in full force and K`r`s�.!✓'-6'._4..� r�r °r�� T •1 SIGNATURE -' I i Y — r <:r n...-,, t , DATE r ' OWNER -BUILDER DECLARATION I hereby affirm [fiat'( am exempt from the Contractors License law for the following reason:_(Sec. 7031.5,8uschew 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 licensed pursuant to the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of Gvison 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 awl penally of not more than five hundred dollars ($500). O 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 p►olesslons Code: The Contractors License Law does not apply to an owner of property who bmTds or 'reproves thereon and who does such work hunself or through his own employees, provided that'such Improvements are not intended of offered for safe. ff, however, the building or improvement is sold within one year of completion. the owner -budder will have the burden 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- 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 protects 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 hereby affirm that I have a certificate of consent to self -insure, or a certificate. of Workers Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.) Policy No Company ❑ Copy is filed with the city. ❑ Certified copy is hereby fumished. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the pemut is for one hundred dollars (8100) 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 Owner NOTICE TO APPLICANT: ff, after makhg 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 pemdt shall bedeemedrevoked. 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.) Lenders Name Lenders Address This is a building permit when property filled out; signed and validated, and is subject to , expiration if work thereunder is suspended for 180 days. I certity that 1 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 061518 Legal Description Project Description Tract 20717-1 1.-_dslists • PLM 1D Sq. Ft. rigs$ • No. No. Dw. Size -Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation �gv st73� PERMIT Plan Chk. Dep. Plan Chk. Bal. Const. Mech. Electrical AMOUNT • Plumbing 120.50 S.M.I. 69.73 Grading Driveway Enc. Infrastructure 11060..58 T.e3.3 Credit 1,080.58 TOTAL $2,487.14 k REMARKS rn.nra?a:z' :+az 4 #;is"i.t) _. a•r: SO X 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: l� ) Date Permit Validated by: Validation: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SQ. FT. ® $ UNITS COLL. AREA B GRADE YARD SPKLR SYSTEM 2ND FL SQ. FT. @ HEATING (ROUGH) STORAGE TANK MOBILEHOME SVC. BAR SINK POR SQ FT ® DUCT WORK ROCK STORAGE POWER OUTLET ROOF DRAINS GAR. SQ. FT. ® HEATING (FINAL) OTHER APPJEQUIP. �- REINF. STEEL DRAINAGE PIPING CAR P. SO. FT. ® WALL SQ. FT. GROUT DRINKING FOUNTAIN. ICE �l FINAL INSP. URINAL SOFT ® BOND BEAM WATER SYSTEM ESTIMATED CONSTRUCTION VALUATION $ GRADING cu. yd. $ -Plus-x$-=$ WATER PIPING NOTE: Not to be used as property tax valuation FINAL INSP. 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 LAUNDRYTRAY 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. SQ. FT. ® c BATH TUB SQ. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 11/4 c SEWAGE DISPOSAL SO.FT.GAR ® 3/4c HOUSE SEWER FINISH GRADING 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 OUND PLUMBING UNDERGROUND A.C. UNIT COLL. AREA B GRADE 0 OUG BONDING HEATING (ROUGH) STORAGE TANK FORMS C/ ER OR SEI�f ROUGH WIRING DUCT WORK ROCK STORAGE UND. REINF. OUGH) 2 ! , METER LOOP HEATING (FINAL) OTHER APPJEQUIP. �- REINF. STEEL GAS (FINAL) TEM . POLE GROUT WATER HEATER ICE �l FINAL INSP. BOND BEAM WATER SYSTEM GRADING cu. yd. $ -Plus-x$-=$ LUMBER GR. FINAL INSP. RAINING ( �'�1 FINAL INSP. ROOFING L VENTILATION O G �6 >0/L4F REMARKS: FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING ME H/0-�� ULATION/SOUND ( D FINISH GRADING FINAL INSPECTION CERT. OCC. ' FENCE FINAL INSPECTOR'S SIGNATURES/INITIALS GARDEN WALL FINAL