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04307 (BLCK)Building Address Owner T4ht 4 4 Qabit P.O. BOX 1504 53 ,;� Obregon 78-105 CALLE ESTADO - - LA QUINTA, CALIFORNIA 92253 Coachella Valley Land co 14111,2 Address 247 E. T81hqLiitz Way i2 CityZip Tel. Palm Sprin i;3 93262 1 .322-1020 Contractor Address City Zip State Lic. City & Classif. 387934 Lic. # 895 Arcn., tngr., 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 1of the Business and P;rofesslons Code, and my license is in full force and effect. 9 ';ia'�:,..-,r.. t.+�f R.. ,.,•a _°"".s,*a"\y,,.;.✓ 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 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 s., Division 3 of the Business and Professions Code, or that. he is exempt therefrom, and the basis for the, alleged exemption. Any violation or Section 7031.5 by any applicant for a permit �'•- subjects the applicant to a civil penalty of not more than five hundred dollars ($500). O 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 whobuilds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) 0 I am exempt under Sec. B. & P.C. for this reason Dale 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 certiffiied�opy!there6ff:<(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 it 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, alter 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 Date Mailing Address City, State, Zip IBUILDING: TYPE CONST, OCC. GRP. A.P. Number 774-075-011 Legal Description Project Description 00 I Rata ni"q Block Wall Sq. Ft. No. No. Dw. Size Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation $11500 PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. Const. • zliu Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure TOTAL REMARKS t.3�.)J�.�� V tt';•'t�usJt�,t.'g• _M�t �,1� 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 INISQECT 0R8 Issued by: Date Permit Validated by: Validation: 1: WHITE.- FINANCE,. PINK APPLICANT; GREEN;. BUILDING, GOLDENROD —ASSESSOR'S OFFICE, HARD COPY - FILE CONSTRUCTION ESTIMATE NO. ELECTRIC,,.'FEES NO. PLUMBING FEES $ IST FL SO FT !p UNITS —'^" -• A.C. UNIT COLL. AREA YARD SPKLR SYSTEM 2ND FL SO FT. a BONDING HEATING (ROUGH) STORAGE TANK MOSILEHOME SVC. BAR SINK POR SO FT. a DUCT WORK ROCK STORAGE FOUND. REINF. POWER OUTLET ROOF DRAINS GAR SO. FT. OTHER APP.IEOUIP. REINF. STEEL GAS (FINAL) TEMP. POLE DRAINAGE PIPING CAR P. SO FT. (d GROUT WATER HEATER WALL SO. FT. a FINAL INSP. DRINKING FOUNTAIN 4$S D BEAM "// WATER SYSTEM URINAL SO. FT. V =$ LUMBER GR. ESTIMATED CONSTRUCTION VALUATION $ FINAL INSP. WATER PIPING NOTE: Not to be used as property tax valuation FLOOR DRAIN MECHANICAL FEES WATER SOFTENER VENT SYSTEM 'FAN EVAP.000L HOOD SIGN WASH ER(AUTONDIS HI APPLIANCE DRYER VENTILATION GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED FIRE ZONE ROOFING LAUNDRYTRAY AIR HANDLING UNIT CFM - 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. SO. FT. ® c BATH TUB SO. FT. @ c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID 1 v. c SEWAGE DISPOSAL SO.FT.GAR rg 3/4c MOUSE 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 8 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.IEOUIP. REINF. STEEL GAS (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. 4$S D BEAM "// WATER SYSTEM GRADING cu. yd. $ plus xE =$ LUMBER GR. FINAL INSP. FRAMING FINAL INSP. ROOFING 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