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04635 (BLCK)Building o1Mm Address 52-965 T4ht 4 MIM P.O. BOX 1504 78-105 CALLE ESTADO LA QUINTA, CALIFORNIA 92253 cxaitlilias l► vaW xAnd Mailin Address 247 E. Ta1KU,tZ WWI #2 City Tel. lZip -]1m�92262 322.023 Contractor I Oxwtxuctim ty State Lic.38'1934 City $� & Classif. Lic. # Arch., Engr., Designer Address Tel. CityI Zip I State 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 �• -�, r _ws. •� 2. ,� � ... •.. f. J SIGNATURE DATE OWNER -BUILDER DECLARATION I hereby affirrp,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 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 thathe is exempt therefrom, andthe 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). 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 or 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.) ❑ 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 f 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 �4 ' A.W O 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 (E100) 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. Signature of applicant Date Mailing Address City, State, Zip LDING: TYPE CONST. OCC. GRP. Number 773-321-01.3 Description Descripti 100' X 3' k1eW� �i 1 .. WHITE - FINANCE, PINK - APPLICANT, GREEN 7 BUILDING, GOLDENROD - ASSESSOR'S OFFICE, HARD COPY - FILE -- Sq. Ft. Size No. No. Dw. Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation�5(1() PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. Const. . Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure TOTAL'��.lE REMARKS r� 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 10/10/88Permit Validated by: Validation: 1 .. WHITE - FINANCE, PINK - APPLICANT, GREEN 7 BUILDING, GOLDENROD - ASSESSOR'S OFFICE, HARD COPY - FILE -- T-,dy 4 44P Q" 046-35 Building Owner P.O. BOX 1504 78-105 CALLE ESTADO LA QUINTA, CALIFORNIA 92253 mailing Address :C:Yt' �r?-,,:F�.i�r City Zip Tel. Contractor Address City lZiD Tel. Cit &tate Cla s1 f. ���ia�=.c.' Licy# -- Arch., Engr., Designer Address Tel. City I Zip I State I J 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. i<KMATURF DA7r OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the fallowing reason: (Sec- 7031. 5:8uslness and PfaFessions Code: Any cffy or county which regwres a permd to construcr. after. Improve, damadish, or repair any structure, prior to its issuance aiso requires the applicant for such permit to file a seyned sfatemanf that he Is licansed pursuant to the provisions of the Contractor's License Law, Chapter 9 (commencing with Suction 7000) of Tlivlsion 3 o1 rho Business and Praleswans Cade, or that he is exempt therefrom, and the basis far the Rugged exemption- Any violation of Section 703f-5 by any appficant for apermk subjacta the appilcant to a 00 peneRy of nor more than Ava hundred dolars IS5001. ❑ 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. fS"- 7044, Bussness and Frofasslons Code. The Contractor's License Law does nor apply to on owner of property who builds or Improves thereon and who does such work himself or through his own employees, Provided that such knprovaments are not intended or offered for sale. 11, howeyer, the building or Improvement is sold within one year of cernpleilan, the owner-bugarer 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.) ❑ 1 am exempt under Sec. B. & P.0 for this reason Date owner WORKERS' COMPENSATION DECLARATION i hereby affirm that I have a Certificate of consent to self -Ensure, or a certificate of Worker's Compensation Insurance, or a certified copy thereof. fSec. 3800, Labor Code.) Policy No. Company [I 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 Owner NOTICE TO APPLICANT: P. after making this Certificate of Exemption you should became subject to the Workers' Compensation provisions of the Labor Cede, 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 inspecilon purposes - Signature of applicant late Mailing Address City, State, Zip BUILDING: TYPE CONST. OCC. GRP. A.P. Number 3 2"! i3 �_. Legal Description Description F' Sq. Ft. No. No. Dw. Size Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal- Const. Mech. Electrical Plumbing S.M.I Grading Driveway Enc. Infrastructure TOTAL ,r Q REMARKS CK .5?M 1U 22Lx7 t ck-t p 813 10 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 :I �� Permit Validated by: Validation: WHITE - FINANCE, PINK - APPLICANT, GREEN - BUILDING, GOLDENROD - ASSESSOR'S OFFICE, HARD COPY - FILE CONSTRUCTION ESTIMATL NO. ELECTRICAL FEES NO. PLUMBING FEES IST FL SO F1 rp $ UNITS SLAB GRADE 2ND FL SO FT. a BONDING YARD SPKLR SYSTEM POR SO FT. a MOBILEHOME SVC. BAR SINK GAR SO. FT. or POWER OUTLET ROOF DRAINS FOUND. REINF. GAS (ROUGH) DRAINAGE PIPING CAR P. SO FT. a OTHER APP.IEOUIP. REINF. STEEL WAIL SO FT. Id TEMP. POLE DRINKING FOUNTAIN SO FT rd GROUT URINAL ESTIMATED CONSTRUCTION VALUATION b FINAL INSP. WATER PIPING NOTE: Not to be used as property tax valuation WATER SYSTEM FLOOR DRAIN MECHANICAL FEES =b WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTONDISH) APPLIANCE DRYER GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED LAUNDRYTRAY AIR HANDLING UNIT CFM 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. SO. FT. ® c BATH TUB SO. FT. g c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID g I W c SEWAGE DISPOSA? SO.FT.GAR rg 3/.c HOUSE SEWER MESH 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 =EE 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 SEPTICY 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. b -plus-x$ =b LUMBER GR. FINAL INSP. FRAMING FINAL INSP. ROOFING I 5 O 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