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BLCK (04583)54420 Avenida Madero 04583 4-4 ' P.O. BOX 1504 ' 78-105 CALLE ESTADO Address 54-420 madem„ LA QUINTA, CALIFORNIA 92253 Owner _ .' Cal West const2:""bC'' i6n - Mailing 'BUILDING: `TYPE CONST. OCC. GRP. Address X499 ve.lia Way A.P..Number 774-232i--007 City Zip Tel. Palm Vesert 1 92260 .146-8864. Legal Description Contractor Project Description 150” X 2" R€tmininl wall $&-rat Address City Zip Tel. State Lic. City & Classif. Lic. # Arch., Engr., y Designer ' Address Tel. City - Zip State Lic. # LICENSED CONTRACTOR'S DECLARATION I Aereby affirm that I am licensed under provision's 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 .+' w s,{,^`✓ r° . SIGNATURE DATE 1 ` OWNER -BUILDER DECLARATION Lhereby 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 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 (8500). 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 • s ` Sq. Ft. No. - No. Dw:' Size Stories Units New ❑' Add ❑ Alter ❑ Repair ❑ :. Demolition ❑ Estimated Valuation PERMIT .Plan Chk. Dep. Plan Chk. Bal. Const. F Mech. AMOUNT 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.) r Electrical !. Plumbing ❑ 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.) ❑ 1 am exempt under Sec. B. 8 P.C. for this reason S•M•1• -50 -Grading Driveway Eric.,. Date Owner Infrastructure WORKERS' COMPENSATION DECLARATION _ ' I hereby affirm that 1 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 furnished. - - - TOTAL .' CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE REMARKS :.s 0051x: _, ,.g; T $•U.7;.,09 '"'1:L.t-55 _7 :c 'T? y: r'.y +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 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. e 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: es' - - j ' Front Setback from Center Line• ` Rear Setback from Rear Prop. Line CONSTRUCTIONLENDINGAGENCY -"' 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 t •.." ' Lender's Address s "` - 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 sauhzerpesentatives of this city to enter the above- • and hereby ponstructionroperty for todpurposes. tFINAL DATE M INSPECTOR `9 /16/88 ^ ISSUed by: - Date Permit ' y, .••mentioned Validated b',r ; , ` •, - `} •, - - Signature of applicant - t Date Mailing Address . Validation: w 'City, State, Zip e - Y GOLDENROD w ASSESSORS OFFICE HARD COPY FILE ..y Y . - .r ...-.,.:...: . .;. :r'+•_ .. . :,.r .•......:;:w - .•.h •.. t-.. °... ,.- r........ ..3;,: r n , ; ,WHITE . FINANCE PINK APPLICANT GREEN BUILDING, w.4.1. :t i',:t w1. `'.'}. :•A. .,d. .eY '. a-.:. r:.,nh.. ..iib; -.•(., ,.. .s✓. . »e s.,. sc: _..'r ,•v,, CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEEn ISI FL SO Fl pr $ UNITS SLAB GRADE 2ND FL SO FT. @ ' YARD SPKLR SYSTEM STORAGE TANK MOBILEHOME SVC. BAR SINK POR SO FT a DUCT WORK ROCK STORAGE GAR SO. FT. a POWER OUTLET ROOF DRAINS HEATING (FINAL) OTHER APP.IEOUIP. DRAINAGE PIPING CAR P. I SO FT. a TEMP. POLE WALL SO. FT. a GROUT DRINKING FOUNTAIN SO. FT. U? FINAL INSP. URINAL ESTIMATED CONSTRUCTION VALUATION $ WATER SYSTEM WATER PIPING NOTE: Not to be used as property tax valuation =$ FLOOR DRAIN MECHANICAL FEES FINAL INSP. WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASH ER(AUTONDISH) APPLIANCE DRYER GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED LAUNDRYTRAY AIR HANDLING UNIT CFM VENTILATION 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 GAR. FIREWALL SO. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID (d 1'A c SEWAGE DISPOSAL SO.FT.GAR ig 3/4c HOUSE SEWER INSULATIONISOUND GAS PIPING PERMIT FEE FINISH GRADING 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 WER OR SEPTIC TANK ROUGH WIRING DUCT WORK ROCK STORAGE OUND. REINF. '%/� -� GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APP.IEOUIP. REINF. STEEL GAS (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. �f /f L SOND BEAM 6 � � �(� 'l 1l/ ( WATER SYSTEM GRADING cu. yd. E 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 SIGNATURESlINITIALS GARDEN WALL FINAL 5Y Y,? O 'P.O. BOX 1504 APPLICATION ONLY Building e• ® 78-105 CALLE ESTADO Addres , LA QUINTA, CALIFORNIA 92253 Own . . ..., ; _ ,.. ,..>_ • , BUILDING: TYPE CONST. OCC. GRP. Mailing "tet' Address7%sy j, d A.P.-Number city R2.25-3 Tel. - ! j Legal Description Contractor Project Description Address City ip Tel.. - State tic./- Q City _- 8r Classif. ,.'9(/% r SCJ Lic. # Sq. Ft. No. No. Dw. _ Size Stories - Units Arch.,.Engr., Designer 1 New ❑ Add Alter ❑ Repair Demolition ❑ Address Tel. ' * l / City Zip State '= Lic.# 1SO CJ ° R/ . LICENSED CONTRACTOR'S DECLARATION - 1 hereby affj(m that 00) I am licensed under provisions of Chapter 9 (commencing with Section t ' 70of S on of theBusinessaann d Professions Code, and my license is in full force andeff ` SIGNATII DATE ' - OWNER-BUILDER DECLARATION Estimated VLilUatlOn hereby affirm that 1 am exempt from the Contractor's License Law for the following • 1., Jl® reason: (Sec. 7031.5,Busbess and Professions Cade: Any city or county which requires a / G✓ permit to constrict; after, improve, demolish, or repairanystructure, prior toits issuance also y .. , _ requires theapplicantfor such permit to file a signed statement that he is•licensed pursuanrto - PERMIT - - F AMOUNT the provisions of the Conlractors 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 basisfor the alleged exemption. Any 'violation of Section 7031.5 by any'applicant for a permit- Plan Chk: Dep:---- - - - - - - • subjects the applicant to a chdpenatly of not more than rive hundred dollars ($500). _ •- Plan Chk. Bal. ❑ I, as owner of the property; or-my employees with wages as.their.sole compensation,_will do the work, and. the structure is not intended or offered for sale. (Sec. 7044, Bulsness and r Const.Professions Code: The Contractor's License Law does -not 'appty•to an. owner of property who builds or improves thereon and who does such -work himself. or,.through his own employees, provided that such improvements are not intended or offered for sale. If, however, the building • Mech.' or improvement is solwithin one year of -completion, the owner-budder. will have the burden Electrical o`tprovig that he dd nat brTd or inprove forthepurpose ofsale.) --_ - ___ ,. _ _ .:1 .i 1, as owner of the property, am exclusively- contracting with licensed contractors to Corr Plumbing struct,the project (Sec. 7044, Business and Professions Code: The Contractor's License Law does not appy to an owner of property, who builds or Improves-thereon, and who contracts for '•$•M•I, :e -' -' "" '"" A` ' 'L such projects with a confrador(s) licensed pursuant to the Contractor's License Law.) -❑ fain exemptunder Sec B. & P.C. for tins, reason - Grading _ 7)19 Driveway Enc. /%/ -`- Infrastructure Date. -5- - r - 7 WORKERS' COMPENSATION DECLARATION . • + -1 hereby- affiro that I have a certificate of consent to self=in5 u `or of Workers Compensation Insurance, or a certified copy thereof: Sec!3800, Labor Code-) - ' • - `Policy No.' Company " ❑ Copy is filed with the city: ❑ Certified co s hereby furnished;- - TOTAL _ CERTIFICA OF EXEMPTION FROM REMARKS WOR RS COMPENSATION INSURANCE .'(nmis serXion •.need not`be' sled If the permit is for'one hundred dollars ($100) valuation - • tY'xi'S - b•r FS •li -2-RY n(- e71U or Less./ y v certify that i e performance of thg work for which this permit is issued, I shall not employ any n in any manner so as to become subject to the Workers' Compensation ' Laws of Ca' omia .. Dat Owner _ - NOTICE TO-APPLICANT. d, after-making, this Certificate of Exemption you should become ZONE: BY: - - t to the Workers' compensation provisions of the Labor Code, you must forthwith comply w1Msuch provisions orOft permit shall bedeemed revoked. - Minimum Setback Distances: 3 Front Setback from Center Line Rear Setback from Rear Prop. Line -- CONSTRUCTION LENDING AGENCY Side Street Setback from Center Line 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.) I Side Setback fromProperty 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 _ - I certify that 1 have read this applyati 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 btjectwn purposes., Validated by: Signature of app ti - Date Mailing Addis Validation: %State, Zip BUILDING DIVISION CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEEW 1ST FL. SQ. FT. ® $ UNITS SLAB GRADE 2ND FL. SQ. FT. ® BONDING YARD SPKLR SYSTEM -_; STORAGE TANK MOBILEHOME SVC. BAR SINK POR. SQ. FT. ® DUCT WORK ROCK STORAGE GAR. SO. FT. ® POWER OUTLET ROOF DRAINS% HEATING (FINAL) OTHER APPJEQUIP. DRAINAGE PIPING CAR P. I SQ. FT. ® TEMP. POLE WALL SQ. FT. GROUT DRINKING FOUNTAIN SQ. FT. ® FINAL INSP. URINAL ESTIMATED CONSTRUCTION VALUATION $ - WATER PIPING NOTE: Not to be used as property tax valuation =$ FLOOR DRAIN MECHANICAL FEES FINAL INSP. WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASH ER(AUTO)(DISH) APPLIANCE DRYER GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED LAUNDRY TRAY AIR HANDLING UNIT CFM VENTILATION IKITCHEN 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 GAR. FIREWALL SQ. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SQ. FT. RESID ® 11/4 c SEWAGE DISPOSAL SQ.FT.GAR ® 3/ic HOUSE SEWER INSULATIONISOUND GAS PIPING PERMIT FEE FINISH GRADING 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 APPJEQUIP. 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