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003278 (BLCK)1 . P.O. BOX 1504 No. 003278 Building �� U ®�QC(ac 78-105 CALLE ESTADO AddressLA QUINTA, CALIFORNIA 92253 Owner - _ Elm W. Olives Mailing BUILDING: TYPE CONST. OCC: GRP. Address A 32<a AQA A.P. Number 773-081-019 City _ - Zip Tel. Tia Qui xi a, 92253 Legal Description Contractor.. ... Project Description 48" X 391iiii BiCCk 4a1�k1i �sT1n I�aai?c'ac-� . Address City Zip Tel.' State Lia City & Classif. Lic. # Sq. Ft. No. No. Dw. Arch., Engr., Size Stories Units Designer New ❑ Add ❑ Alter ❑ Repair ❑ .Demolition ❑ Address Tel. City Zip State Lic. # - LICENSED CONTRACTOR'S DECLARATION. . I 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. SIGNATURE r DATE OWNER -BUILDER DECLARATION Estimated Valuation I hereby affirm that I am exempt from the Contractor's License Law for the following . reason: fSec: 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 t requires the applicant /or 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 of the Business and' Pio/essions "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 Plan Chk. Dep. 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 , . Plan Chk. Bal. do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and COr1St. S20-00 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 _ or improvement is sold within one year o/ completion, the owner -builder will have the burden Electrical Of 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 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 /or. w S. M.1. such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) , Grading ❑ 1 am exempt under Sec. B: 8 P.C. for this reason Driveway Enc. Date owner ! Infrastructure WORKERS' COMPENSATION DECLARATION 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 O Copy is filed with the city. O Certified copy is.hereby furnished. TOTAL 574, . rin CERTIFICATE OF EXEMPTION FROM REMARKS WORKERS'. COMPENSATION INSURANCE (This section need not be completed i/ the permit is for one hundred dollars ($100) valuation or less.) - - 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'-Compensationsr.� , ,i Laws of California. b Y{„ �� i ; �A L " 1J Date ' Owner NOTICE TO APPLICANT: 1/, alter making this Certificate o/ Exemption you should become ' ZONE: BY: subject to the Workers' Compensation provisions o/ the Labor Code, you must forthwith Minimum Setback Distances: - comply with such provisions or this permit shall be deemed revoked. Front Setback from. Center Line Rear Setback from'Rear Prop. Line CONSTRUCTION LENDING AGENCY Side Street Setback from Center Line 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.) Side Setback from Property Line Lender's Name FINAL DATE ' INSPECTOR 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 this +� / �a 12 187 read application and state that the above information. is correct. Issued by: Date i ` a Permit 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. Validated by: Signature of applicant Date Mailing Address Validation: T __ _ City, State, Zip HARD COPY CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SO. FT. ® $ UNITS COLL. AREA 2ND FL. SQ. FT. ROUGH PLUMB. YARD SPKLR SYSTEM MOBILEHOME SVC. BAR SINK POR. SO. FT. ® SEWER OR SEPTIC TANK ROUGH WIRING GAR. SQ. FT. ® POWER OUTLET ROOF DRAINS FOUND. REINF. GAS (ROUGH) DRAINAGE PIPING CAR P. SQ. FT. ® HEATING (FINAL) OTHER APPJEQUIP. WALL SO. FT. ® GAS (FINAL) DRINKING FOUNTAIN SQ FT ® URINAL ESTIMATED CONSTRUCTION VALUATION $ WATER HEATER 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.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED FINAL INSP. LAUNDRYTRAY AIR HANDLING UNIT CFM RL � �� 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 SO. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SQ. FT. RESID ® 11/4 c SEWAGE DISPOSAL GAR. FIREWALL SQ.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 GOND. 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 APPJEQUIP. 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 RL � �� REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATION/SOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS. GARDEN WALL FINAL :d i j � � } -. -__-- ---t ' � - C- - --- --. -- I . -i-:--- _ .. i � �� i � f y f _ - _ _ t � +--- _ I i � - f i - � � � , i� -- } I � I i I � � � t � t } l �. � � _ II_ _ � � 1 + � � � � I - _ _� I� , ' � � �� t - + - �. I - i - ;- - - � - - � t k � � �� ; � � _ _ f_ _ �- � _ '- � -� � � - -- -t + - � - t- i+ + i � - i G � t - - f - F � � .� I I .' � � f} I I i { + � - � - - - -t � ' � � � I I, 1• 1 � - , F - - + � � � � � - i � � - t � -+- � I � ! I i