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06540 (SFD)4 P.O. BOX 1504 Building 78105 CALLE ESTADO Address 54-610 Riviera LA QUINTA, CALIFORNIA 92253 Mailing Address 42-600 Cook St., #20 " City Zip Tel. Palm Dozen 42254 568-2828 Contractor Natiowl Mortgage Address . . Sam City Zip Tel." State Lic. 213 City 323 & 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. f 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, urgrrove, denmofsh, or repair any structure, prior to its issuance also requires the applicant for such permit to We a signed statement that he is fx:ensed pursuant to 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 permit SLOWS the applicant to a civil penalty of not more than five hundred dollars ($500). ❑ 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 Contradces 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. f. however, the building or enprovement is sold wither one year of completion, the owner -bidder will have the burden of proving that he did not build or krprove for the purpose of sale.) O 1, as owner of the property, am exclusively contracting with licensed contractors to con- struct the project. (Sec. 7044, Business and Professions Code: me Contractors 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.) ❑ 1 am exempt under Sec B. & P.C. for this reason Date 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 certified copy thereof. (Sec. 3800, Labor Code.) Policy No Company ❑ Copy is filed with the city. ❑ Certified copy is hereby famished. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed ff the permit is for one hundred dollars (E100) 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 N077CE TO APPLICANT: f, after making this Certificate of Exemption you should become subject to the Workers' Compensation provisionrs of the Labor Code, you must forthwith comply with such provisions or Ods permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the perfornance of the work for which this permit is issued. (Sec. 3097, Chd Code.) Lender's Name Lender's Address This is a building permit when property filled out, signed and validated, and is subject to expiration if work thereunder is suspended for 180 days. I certity 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 No. 06541 BUILDING: TYPE CONST. OCC: GRP. A.P. Number PGA West - TYoet 24317-1 Legal Description Project Description Plan MA r(r/I TOTAL REMARKS 4'.s5 .rrw Ems• •V' zw car s..l 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: Sq. Ft. 3831 Size No. Stories No.,Dw. Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Ir Estimated Valuation $272,603 PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. ,.CI 0.30 Const. 1,245.(W, Mech. 81.50 Electrical 200.45 Plumbing 198.50 S.M.I. 19.11 Grading Driveway Enc. IInffrastru/ctturree $5, i.004.00 3, 00.00 Less Credit asir:iii.r7V TOTAL REMARKS 4'.s5 .rrw Ems• •V' zw car s..l 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. SQ. FT. ® $ UNITS COLL. AREA 2ND FL. SQ. FT. ROUGH PLUMB. YARD SPKLR SYSTEM POR. SQ. FT. ® MOBILEHOME SVC. BAR SINK GAR. SQ. FT. ® POWER OUTLET ROOF DRAINS DUCT WORK DRAINAGE PIPING CAR P. SQ. FT. r14A(ROUGH) METER LOOP WALL SQ. FT. HEATING (FINAL) DRINKING FOUNTAIN. SQ FT ® GAS (FINAL) URINAL ESTIMATED CONSTRUCTION VALUATION $ WATER PIPING NOTE: Not to be used as property tax valuation WATER HEATER FLOOR DRAIN MECHANICAL FEES FINAL INSP. WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER GRADING cu. yd. plus x$ GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED INAL INSP. �� LAUNDRYTRAY AIR HANDLING UNIT CFM OOFING �� 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. SQ. FT. ® c BATH TUB FIREPLACE SO. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.'7.U. SO. FT. RESID ® 11/4 c SEWAGE DISPOSAL SQ.FT.GAR ® 3/ac HOUSE SEWER GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE DBL TO—AL FEES MICRO FEE MECH.FEE PL.CK.FEE CONST. FEE ELECT. FEE SMI FEE PLUMB. FEE STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR SETBACK I U PLUMBING UNDERGROUND A.C. UNIT COLL. AREA B GRADE ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK F MS ER OR SF6�/1� ROUGH WIRING DUCT WORK ROCK STORAGE D. REINF. r14A(ROUGH) METER LOOP HEATING (FINAL) OTHER APPJEQUIP. REINF. STE GAS (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM GRADING cu. yd. plus x$ =$ LUMBER GR. INAL INSP. �� GRAMING ,� V FINAL INSP. OOFING �� _ %/✓ 1 /�J ~ ��j � "' % 3 G U � �i� REMARKS: VENTILATION FIRE ZONE ROOFING: FIREPLACE SPARK ARRESTOR GAR. FIREWALL &LATHING —7' .3 416 MESH INSULATION/SOUND. `RV FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL t