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09151 (BLCK)4: P.O. BOX 1504 N o . 09151 Building Y i,o.•78.105CALLE•ESTADO. Address 51-495 ©$RMN LA QUINTA, CALIFORNIA 92253 Owner $M %DALI. E)WD BUILDING: TYPE CONST. OCC: GRP. Mailing Address City lZip Tel Contractor Address State Lic. I City & Classif. Lic. # Arch.- Engr., Designer Address Tel. CityI Zip I State 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 Professions Code, and my license is in full force and • effect. SIGNATURE 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 rile a signed statement that he Is licensed pursuant to the provisions of the Contractor's License Law, Chapter 9, (commencing with Section 7000) or ;,.i.,,Division 3 of the Business and Professions Code, or that. he is exempt therefrom, and the basis .4dr.•the alleged exemption. Any violation of Section 7031.5 by "any applicant for a permit subjects the applicant to a civil penafty of not more than rive hundred dollars ($500). " �t,� as owner of the property, or my employees with wages as.their sole compensation, will dpflthe 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 or 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- 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 contractors) licensed pursuant to the Contractor's License Law.) ❑ I am exempt under Sec. d B. & P.C. for this reason Date 7. x <+ ' r owner WORKERS' COMPENSATION DECLARATION Ihereby 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 0 Copy is filed with the city.. ❑ 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 the 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. r e" Date__/,!, ' ' ,Owner IF t E NOTICE TbAPPLICANT: If, after-makindrthls `CertificatB or Exemption you should become subject to the Workers' 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 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 inspection purposes. Signature of applicant Date Mailing Address City, State, Zip A.P...Number 773-1,23,011 Legal Description Project Description 230* US' xn-ACM) WATT 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:_ Validated by: Validation: Date Permit Sq. Ft. Size No. Stories No: Dw. Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation 1955.00 PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. Const. �h Mech. Electrical ' Plumbing S.M.I. f- Grading Driveway Enc. Infrastructure :14 TOTAL REMARKS 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:_ Validated by: Validation: Date Permit CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES IST FL. SQ. FT. ® $ UNITS A.C. UNIT COLL. AREA YARD SPKLR SYSTEM 2ND FL. SQ. FT. BONDING MOBIL•EHOME SVC. BAR SINK POR. SQ. FT. ® FORMS SEWER OR SEPTIC TANK GAR. SQ. FT. ® POWER OUTLET ROOF DRAINS DUCT WORK DRAINAGE PIPING CAR P. SQ. FT. GAS (ROUGH) WALL SO. FT. DRINKING FOUNTAIN. SO. FT. ® OTHER APPJEQUIP. URINAL ESTIMATED CONSTRUCTION VALUATION $ WAiER PIPING NOTE: Not to be used as property tax valuation FLOOR DRAIN MECHANICAL FEES GROUT WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER FINAL INSP. GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED WATER SYSTEM 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 SO. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SQ. 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 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 / / �J /G/ ` 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