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002573 (RPL)f44Q P.O. BOX 1504 No., 002573 Building 78-105 CALLE ESTADO Addresst..' + LA QUINTA, CALIFORNIA 92253 Nl13k Tel. BUILDING: TYPE CONST. OCC. -GRP. Mailing Address City 9_ " � A.P. Number /1(41-n _]?// �•`a I ! City Zip Tel. • Legal Description Project Description PM, M lift TIMM RIC 2 A Contractor 03JUMMia P0018 and SrAS .. I OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License'Law for.the following AddressA - _7031.5,Business permiCto construct, alter, Improve, demolish, or repair any structure, prior to its issuance also City.. Zip.. Tel:._. .. PERMIT - - AMOUNT the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of - t:a a2 C 9 4 .323-7303 Plan Chk. Dep.- ' •• alleged exemption. violation o/ applicant a permit subjects -the applicant to a civil penalty of not more than rive hundred dollars'($500).. State Lic. City . ❑ I, as owner of the property, or my employees with wages as their sole compensation, will & Classif. 185102 Lic. # 355 Sq. Ft. No. No. Dw. . AA }}� 1F 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 Size Stories Units � • Arch., Engr., � � •� � Plumbing 12.00 Designer New ❑X Add ❑ Alter ❑ Repair ❑ Demolition ❑ Address Tel. City Zip State Lic. # LICENSED CONTRA%CTOR'S DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Businesys-and Professions Crd e,and my -license is in fulI fand Sorce effect.f_� Q df >f # r /Y/ V (l SIGNATURE'' ,. - .' `. "' - ".'" Sf r! "DATE .. I OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License'Law for.the following Estimated Valuation,,, reason: (Sec. and Professions Code: Any city or county which requiies a _7031.5,Business permiCto 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' PERMIT - - AMOUNT the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of - ' Division 3 o/ the Business and Professions Code, or that. he Isexempt therefrom, and'the'basis for. the Any Section 7031.5 by 'any for Plan Chk. Dep.- ' •• alleged exemption. violation o/ applicant a permit subjects -the applicant to a civil penalty of not more than rive hundred dollars'($500).. _ Plan Chk. Bal. 48.42 . ❑ I, 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 Const. -74.50 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, Mech. . AA }}� 1F 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 - '�( .00 o/ proving that he did not build or improve for the purpose of sale.) 0 I, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing 12.00 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. .60such-projects with a contractor(s) licensed pursuant to the Contractor's License Law.) Grading .❑ 1 am exempt under Sec. B. & P.C.•for this reason Driveway Enc. 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 REMARKS WORKERS'. COMPENSATION INSURANCE (This section need not be completed i/ the permit is /or one hundred dollars ($100) valuation - • or less.) - I 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. Date Owner NOTICE TO APPLICANT: I/, after making this Certificate of Exemption -you should become subject to the Workbrs' '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 thele 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. �e, + 1 %!_•�,/rks _Signature.of applican%IfR "r ate Mailing Address City, State, Zip i HARD COPY 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 Permit Validated by: Validation: A 6 3 0 5 9 9 157,52 CK CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SQ. FT. ® $ UNITS SLAB GRADE 2ND FL. SQ. FT. BONDING YARD SPKLR SYSTEM POR. SQ. FT. ® MOBILEHOME SVC. BAR SINK GAR. SO. FT. ® POWER OUTLET I ROOF DRAINS CAR P. SO. FT. GAS (ROUGH) DRAINAGE PIPING WALL SO. FT. OTHER APP.IEOUIP. DRINKING FOUNTAIN SO. 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.000L 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 SQ. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 11/4 cSEWAGE DISPOSAL GAR. FIREWALL SO.FT.GAR ® 3/ac HOUSE SEWER LATHING 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.IEOUIP. 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