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07810 (SFD)Building" ner • P.O. BOX 1504 No.. 0780 y 78-105 CALLE ESTADO eY MY0 LA �� QUINTA, CALIFORNIA 92253 , Acacia Caiiistruction,v Mailing BUILDING: TYPE CONST. OCC: GRP. Address City. .. Contractor City State Lic., ' & Classif., •,, Arch., EngC,, Designer - Address City - I hereby affirm 7000) of Divisioi effect. . ___ V. Bastanchury A.P. Number Acacia Bore$ Zip Tel. ' 921 714-992—OWG Legal Description Tract 23268 Ptah B-2 Project Description Lot lis Zip Tela City �.. Lic. # Tel. Zip' Lic. # LICENSED CONTRACTOR'S DECLARATION P licensed under.provision�of Chapter 9 (commencing with Section Busines§rangoPiofe9sionf Codg,,.fid my license is in full force and Sq. Ft. No. Size Stories New ❑ ' Add ❑ Alter ❑ `t. No. Dw:'': Units Repair ❑ '. Demolition ❑ -1, -.• :., r/LJd- /T•SIGMATUREf / .✓ DT - ' OWNER -BUILDER DECLARATIONEstimated - I hereby affirm that I am exempt from the Contractor's License Law for the following • reason" (Sec. 703 1.5, Business and Professions Code: Any city' or county which requires a Valuation ��% , PERMIT,:-.;--' 'AMOUNT � - permit' to construct, after, 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) 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 Plan Chk. Dep._ 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 Plan Chk. Bal. , ,� ,,, Const.-, �* -rf - 612 - +v r s Mech..' - r �• - 'i 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 Electrical .`a C..';o'��,� ^, �,. 162-66 ' 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 1-2-040 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 S. M. 1. 58, 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.) • ❑ 1 am exempt under Sec. 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 Cf/Copy is filed with the city. ❑ Certified copy is hereby furnished. r r ^ TOTAL Q REMARKS 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 thr. 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. If �(' �jr� [(�, +��, gg r7s '` z+fa>1510'GA_as�P A-+r+�`fR�405 a�e%-91tiit;ae It'd- j0 -A,.a•.+. a.w raver ' -. . Date Owner - NOTICE TO APPLICANT: If, after 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. ZONE: - BY: Minimum Setback Distances : '- ` Front Setback from Center Line Rear Setback from Rear Prop. 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.) - Side Street Setback from Center Line , Side Setback from Property Line Lender's Name FINAL DATE INSPECTOR -. .5'4 190 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. - Issued by; Validated by: Permit —Date.Permit Signature of applicant Date ' Mailing Address Validation: City, State, Zip 1 l5• t.. f��e'y� S i. .f, # fr 4 • R, • -i it r '.y i's�,•,t i 1 > • 1-''fs]. > ai - 1, 1, i. j14.t' 1, a'. ! (' .4•.•• _r •"F^t . >.,. _ .�., ti. - i+ A ` >'O yy 1..Y, i .. i : Y •-, ' +' . •-a . . w i, -' T •, Wil•.,, CCNSTRUCTION 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 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 BONDING FLOOR DRAIN MECHANICAL FEES FORMS /C1 WATER SOFTENER VENT SYSTEM FAN EVAP.000L HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER GAS (ROUGH) GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED OTHER APPJEOUIP. LAUNDRYTRAY AIR HANDLING UNIT CFM TEMP. POLE 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 FINAL INSP. L SQ. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SQ. FT. RESID ® 1+/. c SEWAGE DISPOSAL SQ.FT.GAR ® 3/ac HOUSE SEWER VENTILATION 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 S�r OUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMS /C1 SEWER OR SEPTIC TANK, �tOUGH WIRING +METER DUCTWORK ROCKSTORAGE FOUND. REINF. GAS (ROUGH) 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. L FRAMIN 40/? - FINAL INSP. ROOFING � �/ ✓( ? � � � REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL .l 0b� LATHING a MESH INSULATIONISOUND�j FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURES11NITIALS GARDEN WALL FINAL