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11067 (RPL)P.O. BOX 1504 N O . 110 s + Building54..545 Qbre on 78-105 CALLE ESTADO _ Address LA QUINTA, CALIFORNIA 92253 Owner Pete Zampaglione Mailing, BUILDING: TYPE CONST.' OCC: GRP. Address '..Tr' ale . A.P. Number. City Zip Tel. La . Quinta 192253. 1. 50-4-43€30 Legal Description Contractor Contemp0 P©n1S Project Description Poo only Address 43-.650 Brownstown Dr' City Zip Tel.: B.D. 92201 360-09-4-4- State Lia �c City ' &Classif: C53 589960 1 Lic.# 441 ' Sq. Ft. 'No. No. Dw. Arch. Engr-, Size--- --- - Stories Units Designer ' New ❑ Add-0 .Alter ❑' Repair ❑ -Demolition ❑ Address Tel. City Zip State Lic. # _ LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensedrunder provisions of Chapter 9 (commencing-with Section .T000) of Division 3o the Business arid Professions Code,—and'my license is in full force and 1 (SIGNATURE a `• �i ` s 7�.,: i DATE OWNER-BUILDER DECLARATION - . , Estimated Valuation `nn 1 hereby affirm that I am exempt from the Contractors License Law for the following • 6, 000 - 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 PERMIT, `'- AMOUNT - the provisions of the Contractor's License Law, Chapter 9 (commencing. with Section 7000) of - 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 pemril__ Plari M. Dep.-'. 'subjects the applicant to a civil penalty of not more than rive hundred dol/am ($500). . ❑ 1, as owner of the property, or my employees with wages as their sole, compensation, will •. Plan Chk.. Bal. ` 52-65 do thework, and the structure is not intended or offered for sale. (Sec. 7044, Business and COrISt. , 1r 81.00 builds Professions Code: The Contractor's License Law does, not appy-to -an owner. of property who ' ca.- builds or improves thereon and who does such work himself or through his own employees,-Mech. - f _-ter' .21..610 - provided that such improvements are not intended or.offered• for sale. -B, however, the building or improvement is sold within one year of completion, the owner-builder will have the burden Electrical' +-' `.�Q.� 00 o1 proving that he did not build or inprove for the purpose of sale.) '❑ 1, as owner of the property, am exclusively contracting with licensed contractors to con- . ' Plumbing .-51',24. Q struct-the .project. (Sec. 7044, Business and Professions Code: The Contractors License Law 6 does not apply to an owner of property who builds or improves thereon, and who contracts for <S.M.I. 00 such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) Grading •- ❑ 1 am exempt under Sec. - B. & P.C. for this reason t , Driveway Enc. Date Owner Y Infrastructure-.• WORKERS' COMPENSATION DECLARATION' I hereby affirm that I have a certificate of consent to self-insure, or a certificate of Workers Compensation Insurance,-or a certified. copy. thereof. (Sec., 3800, Labor Code.). a Policy No Company Y. i Copy is filed with the city. ❑ Certified copy is hereby furnished. ' TOTAL . 209.25 CERTIFICATE OF EXEMPTION FROM REMARKS .'•?x� xr'i.§^•:�;;.pj ,jeJ$; ::Rt,-,.,q''A..�� j;,,, „, S (' WORKERS' COMPENSATION INSURANCE tetiJ $Y" .I. L to t : it d J r ♦t:. { ' (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 fo�which this permit is issued,'I shall not employ any ppeerson in any manner so as to become subject to the Workers' Compensation ` - - - Laws of California. Date - Owner' } NOTICE TO APPLICANT. ti, alter making this Certificate of !Exemption you should .become• ' ZONE: BY: - subject to the 'Workers' Compensation provisions of the Labor Code, you must forthwith - canpty with such provisions or this permit shall be deemed revoked. - - Minimum Setback Distances: - 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 Lenders Name Lenders Address FINAL DATE INSPECTOR 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. Issued by: Date -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: y Signature of applicant Date Mailing Address Validation: City, State, Zip CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SO. FT. ® $ 2ND FL. SQ. FT. POR. SO. FT. ® GAR. SQ, FT. ® CARP. SQ. FT. WALL SQ. 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 ROUGH PLUMB. FLOOR DRAIN MECHANICAL FEES HEATING (ROUGH) WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER ROCK STORAGE GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED LAUNDRY TRAY AIR HANDLING UNIT CFM OTHER APPJEQUIP. 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 WATER SYSTEM SO. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 1% c SEWAGE DISPOSAL SQ.FT.GAR ® 3/ic HOUSE SEWER FINAL INSP. GAS PIPING PERMIT FEE PERMIT FEE I 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 r' GROUND PLUMBIN C UNDERGROUN l A.C. UNIT COLL. AREA SLAB GRADE ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK �A FORMS "{ SEWER OR SEPTIC TANK ROUGH WIRING. DUCT WORK ROCK STORAGE FOUND. REINF. C GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APPJEQUIP. REINF. STEEL UP 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 i/ /J -n � /^ � � 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