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002160 (SATT)44 .0 -wa. P.O. BOX 1504 Building 78-105 CALLE ESTADO Address 80-709 0& MMe LA QUINTA, CALIFORNIA 92253 Owner Mailing Address 75-005 Mmtry Club Dr. City Zip Tel. .. pain Dem . 922517 568'-2828 Contractor Address 71 'City Zip Tel. Sam State Lic. City & Classif. 288130 Lic. # 3n Arch., Engr.; w - Designer Address Tel. City Zip State - Lic. # LICENSED CONTRACTOR'S DECLARATION 1 hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 70 OO) of Division 3 of the Business and Professions Code, and my license is in full force and effect. 1 1 / /I �e SIGNATURE. !?'" `• i' r i-. -[-�*-i.r i.,_d r ♦' DATE 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 he is licensed pursuant to the provisions of the Contractor's License Law, Chapter 9 (commencing .with Section 7000) of Divi ston 3 of the Business aad'Professlons -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 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 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 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.) . O 1 am exempt under Sec. B. li. 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 Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.) Policy No. Company ❑ 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 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. Signature -of applicant f / / f r .� Date .. ,- J!'--1 ` tf Mailing Address City, State, Zip aj 7 HARD COPY No.. 00260 BUILDING: TYPE CONST -.—OCC. GRP. A.P. Number Legal Description Project Description FM PLM IQ R REMARKS 54.377AUNUMN 07 IV ZONE: BY: Minimum Setback Distances: Sq. Ft.1627 Size 4R .424 No. No. Dw. Stories Units New f9' Add ❑ w Alter ❑ Repair ❑ Demolition ❑ Side Street Setback from Center Line Side Setback from.Property.Line FINAL DATE INSPECTOR Issued by: Date 3—"0-8fPermit Validated by: Estimated Valuation :03,666-.50 PERMIT AMOUNT Plan Chk. Dep. S 10 155&76 S1 Plan Chk. Bal. Const. '443.50 Mech. 34.UU Electrical 0.41 Plumbing 87.50 S.M.I. ;. 7. 18 Grading Driveway Enc. Infrastructure i,►5•i TOTAL z,558•Tfa REMARKS 54.377AUNUMN 07 IV 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 3—"0-8fPermit Validated by: Validation: A4661 S 10 155&76 S1 CONSTRUCTION ESTIMATE "` NO. ELECTRICAL FE j NO. PLUMBING FEES 1ST FL. SO. FT. ® $ UNITS A.C. UNIT 2ND FL. SQ. FT. SLAB GRADE WX 7 ZAY YARD SPKLR SYSTEM FOR. SO. FT. ® MOBILEHOME SVC. BAR SINK GAR. SO. FT, ® POWER OUTLET ROOF DRAINS CAR P. SO. FT. OR SEPTIGM1NWIRING DRAINAGE PIPING WALL SQ. FT. DUCT WORK DRINKING FOUNTAIN SO FT ® URINAL ESTIMATED CONSTRUCTION VALUATION $ WATER PIPING NOTE: Not to be used as property tax valuation REINF. STEEL FLOOR DRAIN MECHANICAL FEES TEMP. POLE WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER WATER HEATER GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED FINAL INSP. LAUNDRY TRAY 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 FIREPLACE GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEE MEC:i.FEE PL.CK.FEE CONST. FEE ELECT. FEE SMI FEE PLUMB. FEE STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR SETBACK 1" UND PLUMBING �Tij 6UNDERGROUND A.C. UNIT COLL. AREA SLAB GRADE WX 7 ZAY GH PLUMB. T/ O BONDING HEATING (ROUGH) STORAGE TANK FORMSWER OR SEPTIGM1NWIRING DUCT WORK ROCK STORAGE FOUND. REINF.GI �or, GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APP./EOUIP. 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 -71; FINAL INSP. ROOFING /_/�� VENTILATION REMARKS: FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL �c LATHING MESH I�S JLATIONISOUND w FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESANITIALS GARDEN WALL FINAL