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11299 (BLCK)P.O. BOX 1504 f '` N o . '11299 Building 78-105 CALLE ESTADO Address 52-775 Gbrk gon LA QUINTA, CALIFORNIA 92253 Owner '�� „ Ra'trick Martin aDonnough BUILDING: TYPE CONST. � OCC: GRP. Address same A.P. Number Legal Description Project Description 1471 of 6' block wall City . La. t�txanta Zip 92253 Tel. 564-7035 Contractor .Owner Address . City Zip Tel.' State Lic. & Classif. City Lic. # Sq. Ft. Size No. No. Dw. Stories Units ' Arch.; Engr., Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Address Tel. City Zip State Lic. # LICENSED CONTRACTORS 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 Contractors License Law for the following reason: (Sec. 7031.5,Business and Professions, Code:. Any city.or county which requires a permit to construct, after, 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 Dlvfsion 3 of the Business and Professions Code, or that. he is exempt therefrom, and the basis fdi the alleged exemption. Any violatbn of Section ' 7031.5 by anyapplicant for a permit ' subject§ the applicant to a civil penalty of not more than five hundred dollars.(E500J. .. l��lfs owner of the property, or my employees with wages as their sole compensation, will do the viork,•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 safe. fl, 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.) ❑ 1, 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.) - -' ❑ 1 am exempt under Sec. BA P.C. for this reason . . �''r'� : Estimated Valuation 3 s 675.00 . PERMIT AMOUNT .i. Plan Chk. Dep. - Plan Chk. Bal. COf1St..63_00 Mech. Electrical ' Plumbing.. S.M.I. - .40 Grading Driveway Enc. ' Date Owner , i? (t .' - 1j ;r / 7r g:�,:2.L�=G P/ Infrastructure 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. TOTAL 63.40 CERTIFICATE OF EXEMPTION'FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the -pemut is for one.hundred dollars ($100) valuation or less.) ' I certify that in the performance 027 the work for which this permit is issued, I shall not employ any person in any manner so alto become subject to the'Workers' Compensation Laws of California. � _ f Date Owner sx ` . •" r: 1'f t`f I ` NOTICE TO APPLICANT:. #,--after making this Certificate o1 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'pennit 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 Date Mailing Address City, State, Zip 4 .^. .'N A. 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: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SO. FT. ® $ UNITS COLL. AREA 2ND FL. SO. FT. YARD SPKLR SYSTEM POR. SO. FT. ® MOBILEHOME SVC. BAR SINK GAR. SO. FT. ® POWER OUTLET ROOF DRAINS CAR P. SO. FT. DUCT WORK DRAINAGE PIPING WALL SO. 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 IKITCHEN 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 ® 1% c SEWAGE DISPOSAL FIREPLACE SO.FT.GAR ® 3Yic HOUSE SEWER SPARK ARRESTOR GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEE MECH.FEE PLCK.FEE CONST. FEE JELECT.FEE SMI FEE PLUMB. FEE STRUCTURE / PLUMBING ELECTRICAL 11 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.Ixy GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APPJEOUIP. REINF. STEEL GAS (FINAL) TEMP. POLE Irz 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- U CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL