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002108 (SATT)Building Address F44-377 Oak Owner Smudge Mailing Address 75-005 OX1111 City I Zip Contractor Address - 11C ot P.O. BOX 1504 NO. 002108 78-105 CALLE ESTADO LA QUINTA, CALIFORNIA 92253 BUILDING: TYPE CONST. OCC: GRP. �. A.P. Number Tel. 568x,282$ Legal Description Project Description PIM VM MW 2 0 Tela State Lic. City am 1543 & Classif. Lic. #$ Sq. Ft. 424No. No, Dw. 1 Arch., Engr., Size Stories Units " " Designer New ® Add ❑ Alter ❑ Repair ❑ Demolition ❑ Address Tel. WORKERS' COMPENSATION DECLARATION Ihereby affirm that I have a certificate'of oonsent to self -insure, or a certificate of Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.) Policy No. Company O Copy is filed with the city. O Certified copy is hereby. furnished. 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 of this city to enter the above- " mentioned property for inspection purposes. ' / Signature of applicant �` I 1. •`� f ..�. t Date _Yf _ Mailing Address City, State, Zip HARD COPY TOTAL 2x437_17 2.1^87.17 ZONE: BY: Minimum Setback Distances: City Zip State Lic. # . ' Side Street Setback from Center Line _ 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 Professions Code, and my license is in full force and effect. Side Setback from Property Line • INSPECTOR _SIGNATURE i F '+.+" '•^•< ,✓ - v /' `DATE " f «OWNER -BUILDER DECLARATION 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 repair any structure, prior to its issuance also requires the applicant for such permit to "file a signed statement that be is licensed pursuant to the provisions of the Contractor's License Law, Chapter 9 (commencing with. Section. 7000) of Division 3 bf-the Business and Professions Code, or that: he is exempt therefrom, and the basis for thealleged exemption. Any violation of Section 7031.5' by 'any applicant for a permit. ' 'subjects the applicant to a civil penalty of not more than'rive hundred'dollars ($500). • ' ❑ I, as owner of the property, or my employees with wages as their sole compensation, will do the woik, 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 or property. who 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 or improvement is sold within, one year of completion, the owner -builder 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 projects with a contractor(s) licensed pursuant to the Contractor's License Law.) ElI.am exempt under Sec. B. & P.C. for this reason Estimated Valuation � $.97#623.00 ' ' - 'PERMIT AMOUNT - Plan Chk. Dep. A457.6 Plan Chk. Bal.„ Const., .. Mech.� Electrical' ���� �• Plumbing -. - S.M.I. ,�j,�'� Grading Driveway Enc. Date Owner Infrastructure -1.464.35 WORKERS' COMPENSATION DECLARATION Ihereby affirm that I have a certificate'of oonsent to self -insure, or a certificate of Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.) Policy No. Company O Copy is filed with the city. O Certified copy is hereby. furnished. 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 of this city to enter the above- " mentioned property for inspection purposes. ' / Signature of applicant �` I 1. •`� f ..�. t Date _Yf _ Mailing Address City, State, Zip HARD COPY TOTAL 2x437_17 2.1^87.17 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: A457.6 3 .6 2i87,17 R n CONSTRUCTION ESTIMATE ^ v. NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SO. FT. ® $ UNITS COLL. AREA 2ND FL. SO. FT. YARD SPKLR SYSTEM POR. SQ. FT. ® MOBILEHOME SVC. BAR SINK GAR. SO. FT. ® POWER OUTLET ROOF DRAINS CAR P. I SQ. FT. DUCT WORK DRAINAGE PIPING WALL SQ. FT. iPll 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 WASH ER(AUTO)(DISH) APPLIANCE DRYER GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED GRADING cu. yd. $ plus x$ 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 SQ.FT.GAR ® 3/ac HOUSE SEWER 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/�// ]Z , 12. tZ#AOUND PLUMBING �L UNDERGROUND A.C. UNIT COLL. AREA SLAB GRADE/,1i (Z60UGH PLUMB. S I /J%, BONDING HEATING (ROUGH) STORAGE TANK FORMS f --EWER OR SEPTI ROUGH WIRINGS DUCT WORK ROCK STORAGE FOUND. REINF. J / b iPll GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APP./EQUIP. REINF. STEEL T �� GAS (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM s"Lr WATER SYSTEM GRADING cu. yd. $ plus x$ _ $ LUMBER GR. FINAL INSP. FRAMING S/ /J� fJrJ FINAL INSP. ROOFING 66 / VENTILATION 7 /�/ REMARKS: FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING S MESH INSULATION/SOUND s/ie FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIIINITIALS. GARDEN WALL FINAL 071ylae-1'1'r %� lel.