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BLDG (9811-029)53820 Avenida Martinez 9811-029 15218 06097 003140 LICENSED CONTRACTOR DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (com0iencing with Section 7000) of Division 3 of the Business and Profession4A C de, and my License is in full force and effect. License # Lic. Class Exp. Date Signature of Contractor OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractor's License Law for the following reason: ( ) 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, Business & Professionals Code). ( ) .l, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business & Professionals Code). ( ) I am exempt under Section B&P.C. for this reason Date Signature of Owner WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: (')Mrhave and will maintain a certificate of consent to self -insure for workers' col4ipensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ( ) I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation insurance carrier & policy no. are: Carrier Policy No. (This section need not be completed if the permit valuation is for $100.00 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, and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. Date: 7/ r -'Applicant— Warning: Failure to secure WorkersCompensation coverage is unlawful and shall subject an employer to criminal penalties and civil fines up to $100,000, in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor Code, interest and attorney's fees. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on his application. 1. Each person upon whose behalf this application is made & each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this applicaton agrees to, & shall, indemnify & hold harmless the City of La Quinta, its officers, agents and employees. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is correct. I agree to comply with all City, and State laws relating to the building construction, and hereby authorize representatives of this City to enter upon the above mentioned property for inspection purposes. Signature (Owner/Agent) f/ r ' Date ." 1 PERMIT # BUILDING PERMIT 9X0 1-4#19 VALUATION v , to LOT TRACT DATE tv.3/gs JOB SITE ADDRESS .53-820 AV NIDA MAKV NW., APN - ^ OWNER CONTRACTOR / DESIGNER / ENGINEER I. rl[7-%%TI7Sf . 1. + l4 td+ t f7+!ixr +Y t7T) !•\ n r. ♦ 1. l.lV tld l.f\ 63.820 A.VENIDA..MART1NEZ SAME, LA QUINrlA CA, Q253 r Cy R)t..M USE OF PERMIT GEMRAL OitiLFANO A.I: I ,kC6 2 WINDOWS W1TIM1W DUAL NUC WiKJXJW:i— ArdT) ADTJ h'tftlit lat "E; PA ,. r..,.r.. .. . Nov o " . 1998 1 e Lti: ION 2XA1#A0 p "ITYQF L'ti } +` . g ` ri p QUIIV )A a n fa> i i trit i ii r i +ri ' C 4YIi' T .ii a4iN FFR Ul:YOSIT lot_(W439_3 18 Pf AN s"Y1t r _ r.FH I 129 25 e:';?; :', tt;L'('TOCJ1 t s lai•W()-. 18- i1() S 1SAt x .r-r `I rral, t c inr;.i rzt u,"r CSN AN> t r,A rri t • a 't $7425, +Ae SSA RE-1`AM }LEMS $0.W TOTAL PERM IT FERS1 011 E NMV 57415 RECEIPT DATE BY ' DATE FINALED INSPECTOR .1 v INSPECTION RECORD OPERATION T DATE INSPECTOR OPERATION DATE INSPECTOR • BUILDING APPROVALS MECHANICAL APPROVALS Szt'9acks Underground Ducts Forms & Footings Ducts Slab Grade Return Air Steel Combustion Air Roof Deck Exhaust Fans OX to Wrap // G F.A.U: Framing Compressor Insulation Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath 444 1.a Drywall - Int. Lath Final Final POOLS - SPAS BLOCKWALL APPROVALS Steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Pibg. Test Final Gas Piping PLUMBING APPROVALS Gas Test Electric Final Waste Lines Heater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection Encapsulation Gas Piping Gas Test Appliances Final COMMENTS: Final Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole Underground Conduit Rough Wiring Low Voltage Wiring Fixtures Main Service Sub Panels Exterior Receptacles G. F.I. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) :.S :=v�.f � N�, � ti;..:.,rc� .i �.=�%vJ �%'^'""i=`%JL=''��:.r,'r""C"i;(�ll..rJ:-=i^+�.��ih4K�..:vw' '� -C>^`,t"�,"':e.ri.J:»'Ml';-,:rti.�9'l^.:,.--�:!"���.�:+4?J'L.r^.�..:.fu'-GY"�7.^�ti�J�^«:-nJi:.:-..wT.v%•h.•-s..n�u�r=,rte OWNER/BUILDER INFORMATION Dear Property Owner: An application for a building permit has been submitted in your name listing yourself as the buil& of'ihe property improvements specified. For your protection you should be aware that as "dwner/Builder" you are the responsible party of record on such a permit. Building permits are not required to be signed by property owners unless they are personally performing their own work. If your work is being performed by someone other than yourself, you may protect yourself from possible liability if that person applies for the proper permit in his or her name. Contractors are required by law to be licensed and bonded by the State of California and to have a business license from the City or County. They are also required by law to put their license number on all permits for which they apply. If you plan to do your own work, with the exception of various trades that you plan to subcontract, you should be aware of the following information for your benefit and protection: If you employ or otherwise engage any persons other than your immediate family, and the work (including materials and iiDther costs) is $200.00 or more for the entire project, and such persons are not licensed as contractors or subcontractors, then you may be an employer. If you aie cp employer, you must register with the State and Federal Government as an employer and you are subject to several obligations including State and Federal income tax withholding, federal social security taxes, worker's compensation insurance, disability insurance costs and unemployment compensation contributions. There may be financial risks for you if you do not carry out these obligations, and these risks are especially serious with respect to worker's compensation insurance. Fore specific information about your obligations under Federal Law, contact the Internal Revenue Service (and, if you wish, the U.S. Small Business Adminstration). For more specific information about your obligations under State Lawgcodtact the Department of Benefit Payments and the Division of Industrial Accidents. If the structure is intended for sale, property owners who are not licensed contractors are allowed to perform their work personally or through their own employees, without a licensed contractor or subcontractor, only under limited conditions. A frequent practice of unlicensed persons professing to be contractors is to secure an "Owner/Builder" building permit, erroneously implying that the property owner is providing his or her own labor and material personally. Building permits are not required to be signed by property owners unless they are performing their own work personally. Information about licensed contractors may be obtained by contacting the Contractors' State License Board in your community or at 1020 N. Street, Sacramento, California 95814. Please complete and return the enclosed owner -builder verification form so that we can confirm that you are aware of these matters. The building permit will not be issued until the verification is returned. Very truly yours, CITY OF LA QUINTA DEPT. OF BUILDING AND SAFETY 78-495 Calle Tampico La Quinta, CA 92253 '77-7012 AX ( 60) 7 -701/1 "O BR'S S NATURE/DATE PROPERTY ADDRESS !261� or— 02 ej PERMIT NUMBER(s) Building Address 53_ -- ._Jeffrey Cedr=_ey P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Mailing Address same as above City Zip Tel. La Quinta • 92253 564-6267 Contractor Address & Classif. I Lic. # 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. 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, 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 ($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, Sussness 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 of completion, the owner -builder will have the burden of proving that he did not build or improve for the purpose of sale.) ❑ 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.) O 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 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 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 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. WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE: INTEREST, AND ATTORNEY'S FEES. 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 No. 15218 BUILDING: TYPE CONST. OCC. GRP.- A.P. Number Legal Description Project Description 243 std• ft. Addition Sq. Ft. Size 2443 No. Stories No. Dw. Units New ❑ Add IK Alter ❑ Repair ❑ Demolition ❑ L Estimated Valuation $13,195.00 PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. 125, q A Const. 1513 00 Mech. 21 56 Electrical Plumbing 21 () S.M.I. Grading Driveway Enc. Infrastructure TOTAL REMARKS 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 'Pe reit U Validated by: Validation: I I !AI 1 0 1Q0 Ry CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBIW;FEES 1ST FL. SO. FT. ® $ UNITS SLAB GRADE /A 2r' ��777 (!/ �8 2ND FL. SO. FT. p BONDING YARD SPKLR SYSTEM STORAGE TANK MOBILEHOME SVC. BAR SINK FOR. SO. FT. ® DUCT WORK ROCK STORAGE GAR. SO. FT. ® POWER OUTLET ROOF DRAINS HEATING (FINAL) OTHER APP.IEOUIP. DRAINAGE PIPING CAR P. S0. FT. TEMP. POLE WALL SO. FT. GROUT DRINKING FOUNTAIN SO. FT. ® 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(AUTO)(DISH) APPLIANCE DRYER 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 GAR. FIREWALL LATHING SO. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 11/4 c SEWAGE DISPOSAL SO.FT.GAR ® 3/.c HOUSE SEWER INSULATIONISOUND / FINISH GRADING 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 /A 2r' ��777 (!/ �8 ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMS Q� SEWER OR SEPTIC TANK ROUGH WIRING DUCT WORK ROCK STORAGE FOUND. REINF. / GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APP.IEOUIP. 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 d /�1 FINAL INSP. ROOFING / REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATIONISOUND / FINISH GRADING FINAL INSPECTION 3// CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURES/INITIALS GARDEN WALL FINAL M _-�V DESERT SANDS UNIFIED SCHOOL DISTRICT 82-879 Highway 111 NOTICE: Indio, CA 92201 Document Cannot Be Duplicated 619-775-3500 Date 11/9/95 1 Type of Permit I La Quinta No. 13856 Permit # Log Owner Name Jeffrey Gedney No. 53820 Street Avenida Matinez City La Quinta Zip 92253 Study Area 113 APN # I Tract # I J Lot # 0 Square Footage 1243 Type of Development I Residential Addition. I No. of units Comments At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered patios/walkways, residential additions under 500 square feet, detached accessory structures or replacement mobilehomes. It has been determined the above-named owner is exempt from paying school fees at this time due to the following reason: Residential Addition 500 Sq Feet or Less EXEMPTION NOT APPLICABLE This certifies that school facility fees imposed pursuant to Government Code 53080 in the amount of 0.00 x 243 or $ 0.00 have been paid to D.S.U.S.D. for the property listed above and that building permits and/or Certificates of Occupancy for this square footage in this proposed project may now be issued. Fees Paid By. N/A Name on the check By Dolores A. Ballesteros Superintendent Fee collected /exempted by Pauline Pearson Signature ^p ,nom Collector: Attach a copy of county or city plan check application form to district copy for all waivers. Embossed Original- Building Dept./Applicant Copy - Applicant/ Receipt Copy - Accounting Telephbbne�;�-� $0.00 Check No. N/A Collector: Attach a copy of county or city plan check application form to district copy for all waivers. Embossed Original- Building Dept./Applicant Copy - Applicant/ Receipt Copy - Accounting Building 53-820 Martinez P.O. BOX 1504 78-105 CALLE ESTADO LA QUINTA, CALIFORNIA 92253 Owner I Jeffrey D. Gedney Mailing Address u 8 City Zip Tel. La'Quinta 92253 5V4-626 Contractor QmtL+l /Buil .d'a City State Lic.I City & Classif. Lic. # Designer Address Tel. CityI Zip I State I Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that 1 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. 7031.5,8usiness and Professions Code: Any city or county which requires a permit to construct, after, irprove, demolish, or repair any structure, prior to its issuance also requires the applicant for such permit to No a signed statement that he is licensed pursuant to the provisions of the Contractors 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 penally of not more than five hundred dollars (5500). ❑ 1, 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, Suisness and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon and who does such work hmnself or through his own employees, provided that such improvements are not Trended or offered for sale. If, however, the building or improvement is said withn erre year of completion, the owner -budder will have the burden of proving that he did Trot build or irprove for the purpose or sale.) ❑ 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 contractors) licensed pursuant to the Contractor's License Law.) O 1 am exempt under Sec_ R, & P.C. for this reason 7 i 7 • r w '." Date Owner 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.) Policy No. Company ❑ Copy is filed with the city. O Certified copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed ff the permit is for one hundred dollars ($100) valuation or less.) 1 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 NOTICE TO APPLICANT. fl, after ,making' Otis 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 pemtit 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, Ciel Code.) Lenders Name Lenders 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 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 No. 06097 BUILDING: TYPE CONST. OCC: GRP. A.P. Number 774-^172- Legal Description Project Description Sna Sq. Ft. Size No. No. DIN. Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation ti 6U17, PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. Const. $15.00 Mech: 30.00 Electrical 27.00 Plumbing 24.00 S. M.I. .03 Grading Driveway Enc. Infrastructure TOTAL REMARKS ,,. „r, A:, 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 7/19189 Issued by: Date Permit Validated by: Validation: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL SQ. FT. ® $ UNITS SLAB GRADE 1 H PLUM B% `j! BONDING 7 YARD SPKLR SYSTEM 2ND FL SQ. FT. @ FORMS SEWER OR SEPTIC TANK ROUGH WIRING. MOBILEHOME SVC. BAR SINK POR. SQ. FT. ® GAS (ROUGH) METER LOOP GAR. SQ. FT. ® POWER OUTLET ROOF DRAINS GAS (FINAL) TEMP. POLE DRAINAGE PIPING CAR P. SQ. FT. ® GROUT WATER HEATER WALL SQ. FT. FINAL INSP. DRINKING FOUNTAIN. BOND BEAM WATER SYSTEM URINAL SQ FT ® LUMBER GR. ESTIMATED CONSTRUCTION VALUATION $ FRAMING WATER PIPING NOTE: Not to be used as property tax valuation I FLOOR DRAIN MECHANICAL FEES REMARKS: WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER 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. SQ. FT. ® c BATH TUB MESH SQ. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 11/4 c SEWAGE DISPOSAL FINISH GRADING SQ.FT.GAR ® 3/ic HOUSE SEWER 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 UNDER A.C. UNIT COLL. AREA SLAB GRADE 1 H PLUM B% `j! BONDING 7 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 FINAL INSP. •' - GRADING cu. yd. $ -plus-x$-=$ LUMBER GR. FRAMING FINAL INSP. ROOFING I REMARKS: VENTILATION FIRE ZONE ROOFING: FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATION/SOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL 4 P.O. BOX 1504 N o . 003140 Building 78-105 CALLE ESTADO Address 53"820 Avenida Martinez LA QUINTA, CALIFORNIA 92253 Mailing Address City Zip Contractor .. . Ower/Builder Address BUILDING: TYPE CONST. OCC: GRP. A.P. Number 77A-1 7>—nm Tel. 7 . Legal Description Project Description 601 of .4 1/2 33lepck Wail CERTIFICATE OF EXEMPTION FROM REMARKS WORKERS' COMPENSATION INSURANCE :• (This section need not be completed if the permit is for one hundred dollars ($100) valuation 1 t;•rf`'*,„` r 'y`i J' i f ;'1!T, i .' + or less.) - I certify that in the performance of lhg 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 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. 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'lhe 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 HARD COPY ZONE: BY: Minimum Setback Distances: City Zip Tela Side Street Setback from Center Line State Lic. & Classif. City Lic. # Sq. Ft. Size 60 No. No. Dw. Stories Units ' Arch., Engr., ._ .. . Designer New ❑ Add ❑ Alter ❑, Repair ❑ Demolition ❑. Address Tel. Validation: City Zip State Lic. # J 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. . 1- ' _SIGNATURE DATE OWNER -BUILDER DECLARATION I hereby 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 asis 'Division 3 or the Business' and Professions Code, -or that. he is exempt therefrom, and the basis—'Plan 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). ❑ 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 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.) ❑ 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 contractors) licensed pursuant to the Contractor's License Law.) ❑ I am exempt under Sec. B.•& P.C. for this reason / Estimated Valuation 1 e7 . - PERMIT AMOUNT * - n Plan Chk. Dep. .Plan -Chk• Bal. COr1St..Z si Mech. ' Electrical ' Plumbing S.M.I. Grading Driveway Enc. Date ! k Owner f ` ✓ ✓" _r 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 ❑ Copy is filed with the city. . ❑ Certified copy is hereby. furnished. TOTAL $AZID .><i{) CERTIFICATE OF EXEMPTION FROM REMARKS WORKERS' COMPENSATION INSURANCE :• (This section need not be completed if the permit is for one hundred dollars ($100) valuation 1 t;•rf`'*,„` r 'y`i J' i f ;'1!T, i .' + or less.) - I certify that in the performance of lhg 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 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. 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'lhe 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 HARD COPY 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 619187 Permit Validated by: Validation: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SO. FT. ® $ 2ND FL. SQ. FT. POR. SQ. FT. ® GAR. SO. FT. ® CAR P. Q. FT. p 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 WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASH ER(AUTO)(DISH) APPLIANCE DRYER GAS (ROUGH) GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED OTHER APP.IEQUIP. 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 SQ. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SQ. FT. RESID ® 1+/a c SEWAGE DISPOSAL SQ.FT.GAR ® 3/ac HOUSE SEWER REMARKS: 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 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 APP.IEQUIP. 06 EINF. STEE —/a— GAS (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. ^ BOND BEAM c ( V 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 UzFINAL INSPECTION 3 8 v CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURES/INITIALS. GARDEN WALL FINAL