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13476 (PAT)Building Address Owner j P.O. BOX 1504No, 13476 44 Seeley ��$ 78-105 CALLE ESTADO LA QUINTA, CALIFORNIA 92253 Stephen Ziem Mailing Same Tay Quinta CAT 92253 Contractor Owner Address City State Lic. & Classif. Arch.; Engr., Designer Zip BUILDING: TYPE CONST.: OCC: GRP. A.P. Number 4. Legal Description Project dscription �aii6 r• Tela City Lic. #.',_. Sq. Ft. 2$0 �;:No:'r;'`:, No. Dw. Size Stories" Units ='. New O 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 Contractors 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 rile a signed statement that he is licensed pursuant to. the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) or, 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). , e01, 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 or completion, the owner -builder willhave the burden . of proving that he did not build or improve for the purpose of sale.) O 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 such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) 0 1 am exempt under Sec. B. & P.C. foi this reason 'Date t" r. '� ✓!� Owner ✓ r 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 O Copy is filed with the city. ❑ Certified copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (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 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 �Wit'+; 'Owner , n•-�vCz „tike •, NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become 1kbject to the Workers' Compensation provisions or:: the Labor Code, you must forthwith omply 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 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` ZONE: BY: r ! r Minimum Setback Distances: o __ _. Front Setback from Center Line Rear Setback from Rear Prop. Line Side Street Setback from Canter Line Side Setback from Property 6-ne- FINAL DATE INSPECTOR Issued by: Date Permit Validated by: Validation: • r •Tr � .. ' f Estimated Valuation.. 6 3'�.+qg`Lw� p 4a0V {�pA� . di .. PERMIT AMOUNT .� • ., Plan Chk. Dep. _ Plan Chk. Bal. , _ ' • 7 Const. v... v. 1 Mech. ` Electrical Plumbing _ .S.M.L . Grading Driveway Enc. Infrastructure J t ' �l.Y' .� TOTAL ` REMARKS If � MAY 0 9 3004 ZONE: BY: r ! r Minimum Setback Distances: o __ _. Front Setback from Center Line Rear Setback from Rear Prop. Line Side Street Setback from Canter Line Side Setback from Property 6-ne- FINAL DATE INSPECTOR Issued by: Date Permit Validated by: Validation: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SO. FT. ® $ UNITS SLAB GRADE 2ND FL. SO. FT. BONDING YARD SPKLR SYSTEM POR. SO. FT. ® MOBILEHOME SVC. BAR SINK GAR. SO. FT. ® POWER OUTLET ROOF DRAINS CAR P. SO. FT. GAS (ROUGH) DRAINAGE PIPING WALL SO. Ff. - DRINKING FOUNTAIN SO FT ® TEMP. POLE URINAL ESTIMATED CONSTRUCTION VALUATION $ GROUT WATER PIPING NOTE: Not to be used as property tax valuation FINAL INSP. FLOOR DRAIN MECHANICAL FEES - — WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER FINAL INSP. GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED 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 ® 11/4 c SEWAGE DISPOSAL GAR. FIREWALL SO.FT.GAR ® 3/ac HOUSE SEWER LATHING 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 APPJEOUIP. 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 INSULATIONISOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL V631 Jzr I 1.5z, T 77 CITYOF LA Q(.es,11; NTA 4yr TME NT".� BUILDING & SAFE' COIND"n ,LLY AWEPTE.� MOT TO lt%4.,T TION AS 4 - - - - - - - - - - a DATE du V631 Jzr I 1.5z, T 77 CITYOF LA Q(.es,11; NTA 4yr TME NT".� BUILDING & SAFE' COIND"n ,LLY AWEPTE.� MOT TO lt%4.,T TION AS 4 - - - - - - - - - - a DATE � ,� Z, �>�laCE � T-S`lKlsiPf s+7T•4c1��D u'% 2dO�,ly �,� �2 ycvvo� -`� �t1l G /� s �4c ✓ �'�e ci:/ coi>E W,4 tl- CITY OF LA 01 111NIT BUILDING & SAFF-V '=' _ MENT °3 . ACCEPTED,..y, AND ALL A Lc v0LE's , AAlcLfO,fS @4Z4c11 firATE _ 13 ,.' 7;p 'A 07Nth o T r 40 At'f.` -� t .- its/-- �x%ST��Z 7.o SECS • �� _W ram -B Lvc_Kjfu 67 \fAM -'59NN Is �Voc�a till CITY OF L-A uip BUILDING. &--SAFETY f'r_:RPkhR I DENT CONDMov ACCEPTED �M i0l M5 SUEJE: TTO IN AND ALL DES DAT BY r� rz 'I /Ca2,c.1� �WG��. -STU ZK, 6 L Ate, 1 7 71, Uri, aa�5 Y/M qxq 'c `4 4, &W7_;;k 1