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04620 (SOTB)__ _ _ _—_ _— _+!! TAt�t • �� 5/-00l ogVENIVA 0AeX A9Zl1 P.O. BOX 1504 Building 78-105 CALLE ESTADO Address `""`"'` + . - • - - •• .LA QUINTA, CALIFORNIA 92253 Owner ✓ r'`'.o•S/�! T �t Vii, Pts* BUILDING: TYPE CONST. Mailing Address P. 0. 21000 y _ City. Zip Tel. ' �rt �► �r<ttt7 �� _ •.. Contractor +• li3 . Address State Lic. City & Classif. Lic. # ... _..., ......I Designer Address Tel. City I Zip I State Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that Ijam licensed underprovisions of Chapter 9 (commencing with 7000) of Divis,ioorn3 of �hd Business and Professio s Code, and my lice s.in full ft effect. V Ls}' f�� _,gc s !� . u I r 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 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 (E500). 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 „ or improvement is sold within one year of completion, the owner -builder will have the burden or proving that he did not build or improve for the purpose of sale.) ❑ 1, 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. & 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. O 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 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 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. r Signature of applicant Date Mailing Address City, State, Zip P. Number - --. OCC. GRP. 04620 Legal Description Project Description (blf V1+1tem=~wiMim Sq. Ft. '* '2132 No. 'No. Dw. Size Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ t€3 fc3]' ftal t&* mid dll39im 4A be Estimated Valuation 9/843 PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. '4 ��•�� Const. Mech. Electrical �C4 r i;3 Plumbing ��aUU S.M.I. Grading Driveway Enc. InfrastructureC�rJii. O TOTAL � �.9��Lft3.lti ��'f% �� �S %•%s REMARKS ZONE: BY:1��`iiitx►. 1.0 io-i4-88. -..'t4 Minimum Setback Distances: i,naf t i. w tr r nf_ It Front Setback from Center Line Rear Setback from Rear Prop. Line Side Street Setback from Center Line Side Setback from Propert y Line FINAL DATE I N,TO iR;y Issued by: Date /� Permit Validated by: Validation: ' WHITE -FINANCE, PINK -APPLICANT, GREEN -BUILDING, GOLDENROD -ASSESSOR'S OFFICE, HARD COPY- FILE tJ TOTAL � �.9��Lft3.lti ��'f% �� �S %•%s REMARKS ZONE: BY:1��`iiitx►. 1.0 io-i4-88. -..'t4 Minimum Setback Distances: i,naf t i. w tr r nf_ It Front Setback from Center Line Rear Setback from Rear Prop. Line Side Street Setback from Center Line Side Setback from Propert y Line FINAL DATE I N,TO iR;y Issued by: Date /� Permit Validated by: Validation: ' WHITE -FINANCE, PINK -APPLICANT, GREEN -BUILDING, GOLDENROD -ASSESSOR'S OFFICE, HARD COPY- FILE CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES IST FL 50 FT iq S UNITS A.C. UNIT COLL. AREA SLAB GRADE 414 YARD SPKLR SYSTEM 2ND FL SO FT. a BONDING HEATING (ROUGH) MOBILEHOME SVC. BAR SINK POR SO FT. a ROUGH WIRING POWER OUTLET ROOF DRAINS GAR SO. FT. a GAS (ROUGH) METER LOOP DRAINAGE PIPING CAR P. SO FT. a ,�y�FyOLU�ND. w 41,14 ,/' �R I EEL GAS (FINAL) WALL SO FT. a DRINKING FOUNTAIN URINAL SO. FT. a ESTIMATED CONSTRUCTION VALUATION $ FINAL INSP, WATER PIPING NOTE: Not to be used as property tax valuation WATER SYSTEM FLOOR DRAIN MECHANICAL FEES WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASH ER(AUTONDISH) APPLIANCE DRYER R M1tJG GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED FING 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 C 1 v. c SEWAGE DISPOSAL 0 SO.FT.GAR a 3/� c HOUSE SEWER Vt I G GAS PIPING PERMIT FEE M SH 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 OUND PLUMBIN UUU!!! UNDERGROUND A.C. UNIT COLL. AREA SLAB GRADE 414 ROUGH PLUMB BONDING HEATING (ROUGH) STORAGE TANK FORMS SEWER OR SEPTIC TANK ROUGH WIRING DUCT WORK ROCK STORAGE REINF. GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APP.IEOUIP. ,�y�FyOLU�ND. w 41,14 ,/' �R I EEL GAS (FINAL) TEMP. POLE OUT 1 C WATER HEATER SERVICE FINAL INSP, BOND BEAM WATER SYSTEM GRADING cu. yd. $ plus x$ = $ LU BER GR. FINAL INSP. R M1tJG FINAL INSP. FING JC.. %v��/ Dy �\i�. C� REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR G R. FI WALL Vt I G M SH UITIONISOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL Building Address Owner �lJEftll_' � ���LAP.O. BOX 1504 78-105 CALLE ESTADO QUINTA, CALIFORNIA 92253 Mailing Address �' , /s + v, �✓Jp City ! Zip Tel. Contractor APPLICATION ONLY BUILDING: TYPE CONST. t OCC. GRP. A.P. Number L___ Legal Description Project Description U'- f%%� �� T!�....�l vG f-✓.,wrtG '>,,O A'I City Zip' Tel. �p/S�i.=tiS��v f '7a I�� O✓�TA�.v,�0 f2o�''� State Lic. City Fj/L� /Yl/9.2Sf/.4Lr` & Classif. Lic. # Sq. Ft. Size / No. No. Dw. Stories Units Arch., Engr., Designer Newer 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) t. of Division 3 of the Business and Professions Code, and my license is in full force and effec SIGNATURE DATE OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractoes 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 ($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 Lew 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.) Estimated Valuation / 7� PERMIT r AMOUNT Plan Chk. Dep. Plan Chk. Bal. — / �, _ / , Const. Mech. o� Electrical �- Plumbing 3% Oc� ❑ 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. & P.C. for this reason S.M.I. Grading Driveway Enc. Date Owner Infrastructure WORKERS' COMPENSATION DECLARATION Ihereby 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. O Certified copy is hereby furnished. TOTAL 35-7g.10 CERTIFICATE OF EXEMPTION FROM WORKERS'COMPENSATIONINSURANCE (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. REMARKS 22 lc-IC41F 41Z Or/j Date Owner NOTICE TO APPLICANT: If, alter making this Certificate or 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 Side Street Setback from Center Line 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 Setback from Property Line Lender's Name FINAL DATE INSPECTOR 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 sof this city to enter the above- mentioned property for inspection purposes. Issued by: Validated by: Date Permit Signature of applicant Date Mailing Address Validation: City, State, Zip _ f BUILDING DIVISION CONSTRUCTION ESTIMATE GROUND PLUMBING NO. ELECTRICAL FEES NO. PLUMBING FEES �^1 1STFI-02 SQ. FT. 1-MC12140 $ 'Ire'13UNITS SLAB GRADE ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK 2ND FL. SO. FT. SEWER OR SEPTIC TANK ROUGH WIRING DUCT WORK YARD SPKLR SYSTEM FOUND. REINF. FOR. SO. FT. ® METER LOOP MOBILEHOME SVC. OTHER APP./EQUIP. BAR SINK GAS (FINAL) - GAR. SQ. FT. ® POWER OUTLET GROUT ROOF DRAINS SERVICE CAR P. SO. FT. BOND BEAM WATER SYSTEM DRAINAGE PIPING GRADING cu. yd. $ plus x$ WALL SO. FT. LUMBER GR. FINAL INSP. DRINKING FOUNTAIN FINAL INSP. SO. FT. ROOFING _ URINAL y ESTIMATED CONSTRUCTION VALUATION $ VENTILATION WATER PIPING NOTE: Not to be used as property tax valuation FIREPLACE FLOOR DRAIN MECHANICAL FEES WATER SOFTENER GAR. FIREWALL VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) MESH APPLIANCE DRYER GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED FINISH GRADING LAUNDRYTRAY AIR HANDLING UNIT CFM CERT. OCC. KITCHEN SINK ABSORPTION SYSTEM. B.T.U. TEMP USE PERMIT SVC INSPECTOR'S SIGNATURESIINITIALS WATER CLOSET COMPRESSOR HP GARDEN WALL FINAL POLE, TEMIPERM LAVATORY HEATING SYSTEM FORCED GRAVITY AMPERES SERV ENT SHOWER BOILER B.T.U. SO. FT. ® c BATH TUB 3 (/AP S SO. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SQ. FT. RESID ® 1+/4 c SEWAGE DISPOSAL cp Ila SO.FT.GAR ® 3/acC4pyHOUSE SEWER GAS PIPING PERMIT FEE /Q PERMIT FEE PERMIT FEE �Q DBL TOTAL FEES MICRO FEE MECH.FEE PL.CK.FEE CONST. FEE ELECT. EE SMI FEE PLUMB. FEE A. sO 3V. / V 7, 00 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./EQUIP. 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