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001672 (BLCK)• I 44 P.O. BOX 1504 N o . Buil&ng78-105 CALLE ESTADO a Address 53 - Lada axegm LA QUINTA, CALIFORNIA 92253 Owner Mailing Address Sme as abmt-a City Zip Tel. . : La Quinta 92253 . Contractor DobbilkMa=tom Address . A.s�nida DiAn City Zip. Tel. La QWxta 1 92253 564-3447 BUILDING: TYPE CONST. OCC: GRP. P. Number Legal Description Project Description Pmt to, o, � 50 W 5 k State Lic. & Classif.. 460284 City Lic. # 295 Sq. Ft. No. No. Dw. Size - Stories Units Arch:, Engr., 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 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 Estimated Valuation Q�q �d� �t� $325 ilo1� 0. ' • • 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 - PERMIT - - AMOUNT the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000). of ' Plan Chk..Dep. - " Division 3 of the Business and Professions 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).. 0.1 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 Plan Chk. Bal.. tsa30 Const. Mech.' - - 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. It, however, the -.building Electrical - 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.) Plumbing -• . ❑ 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 S.M.I.a5; such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) . ❑ I am.exempt under. Sec.- B. B, P.C. for this reason Grading Driveway Enc. Date Owner 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.. ❑ Certified copy is hereby furnished. TOTAL .g'1ogJ CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION. INSURANCE REMARKS (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 or which, this permit is jssued, I shall not employ any person -in any -manner -so as to become subject:.to;,lhe Workers' Compensation Laws of California. Date Owner' ✓ �' �� ! hr NOTICE TO APPLICANT: If, attei'm wAg this Certificate of— ­Exempt `ou—should become - ZONE: BY: subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. -' Minimum Setback Distances: - Front.Setback from Center Line Rear Setback from Rear Pro Line 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. 1 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 HARD COPY P• Side Street Setback from Center Line Side Setback from Property Line . FINAL DATE INSPECTOR Issued by: Date Permit Validated by: Validation: A2291 8 13 3686 Ck. CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SO. FT. ® $ 2ND FL. SQ. FT. POR. SQ. FT. ® GAR. SQ. FT. ® CAR P. SQ. FT. WALL SO. FT. ® SQ. FT. ® ESTIMATED CONSTRUCTION VALUATION $ UNITS MOBILEHOME SVC. POWER OUTLET YARD SPKLR SYSTEM ` BAR SINK ROOF DRAINS DRAINAGE PIPING DRINKING FOUNTAIN URINAL WATER PIPING NOTE: Not to be used as property tax valuation BONDING FLOOR DRAIN MECHANICAL FEES FORMS WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASH ER(AUTO)(DISH) APPLIANCE DRYER GAS (ROUGH) GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED OTHER APP./EQUIP. LAUNDRY TRAY AIR HANDLING UNIT CFM TEMP. POLE 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. SQ. FT. RESID ® 11/4 c SEWAGE DISPOSAL SQ.FT.GAR ® 3/ac HOUSE SEWER REMARKS: 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 APP./EQUIP. 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 , REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATION/SOUND FINISH GRADING �eNAL INSPECTION Zf� CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL