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001932 (SATT)4 P.O. BOX 1504 No, 001932 Building 78-105 CALLE ESTADO Address 55-710 Oak Trw LA QUINTA, CALIFORNIA 92253 Owner S=im 0=911M BUILDING: TYPE CONST. VN OCC. GRP. R-~3 Mailing Address 75-005 CbUrlt n% Club A iVa A.P. Number City Zip T. . S 9226fl 568-2828Legal Description Contractor Project Description fit' 1 Hartmae Land Address . PIM 40 0 City Zip Tel. 1116 a 0 State Lic. City M 3142 & Classif. Lic. # Sq. Ft. IpR 589 No. No. Dw. Arch., Engr., Size Stories Units 1. Designer ftbeft A.teVIWS ASS=. New IR Add ❑ Alter ❑ Repair ❑ Demolition ❑ Address Tel. 2915 iisd Hila. Avg. 4714 j 54€f-55317 City Zip State 01"Irta Ywa 92625 Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with'Section 7000) of Division 3 of the Business and PFofessions Code; and -my license its in full.forrce'e'and w SIGNATURE—_ DATE _ OWNER -BUILDER DECLARATION % I hereby affirm that I am exempt from the Contractor's License Law for the following Estimated Valuation �r� x reason: (sec. 703 1.5, Business, ind Professions Code: Any .city or county which requires a A 4s34 permit to construct, alter, improve, demolish, or repair any *Structure, prior to its Issuance also AMOUNT requires the applicant for such permit to file a signed statement that he is licensed pursuant to PERMIT ' the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of Division 3 or the Business and Professions. Code, or that. he is exempt therefrom, and the basis for the alleged exemption. Any violation or 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). O 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. 7044, Buisness and Const. 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. - provided that such improvements are not intended or offered for sale. If, however, the building •00 L or improvement is sold within one year of completion, the owner -builder will have the burden' Electrical 328 s�t5 of proving that he did not build or improve for the purpose of sale.) O I, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing �t7.5© 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. 13.83 such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) . Grading •O I am exempt under Sec. B. & P.C. for this reason Driveway Enc. Date Owner Infrastructure 2,=.00 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,furn!shed. TOTAL 3,580.17 • 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.) 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. If, after making 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 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 if 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 sof this city to enter the above- mentioned property for inspectn purposes. o Signature of applicant,. -Date , Mailing Address y t' Validation:_ City, State, Zip C A3535 HARD COPY T REMARKS MilITA AAS 19PA Wr PAW (IF TM8 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 12-10-85 Permit Validated by: 12 1 10 3580 17 CC _. CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SO. FT. ® $ UNITS COLL. AREA 2ND FL. SO. FT. YARD SPKLR SYSTEM POR. S0. FT. ® MOBILEHOME SVC. BAR SINK GAR.. SO. FT. ® POWER OUTLET ROOF DRAINS CARP. S0. FT. DUCT WORK DRAINAGE PIPING WALL S0. 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$ 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. SO. FT. ® c BATH TUB SO. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 11/a c SEWAGE DISPOSAL FIREPLACE SO.FT.GAR ® 3/ac HOUSE SEWER SPARK ARRESTOR 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 , G� 1 SEWER OR SEPTIC TAIJK 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