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08484 (BLCK)Building Address 54 Owner ' u P.O. BOX 1504 78-105 CALLE ESTADO LA QUINTA, CALIFORNIA 92253 Mailing Address City Zip Tel. . "I'"M 92107 61191927—AnS't Contractor Address. Baal: 1012 Zip Tela & Classif. 9971330 I Lic`# Arch., Engr., Designer Sgt Tt� Address I Tel. S+ntifs l Ago 1 921a7 -I Lic. # LICENSED -CONTRACTOR'S DECLARATION I hereby affirm that I arwlicenseclander provisions of Chapter 9 (commencing with Section 7000) of Division 3-of%th6 Business and Professions Code, and my license is in full force and effect.'' SIGNAT.UREVDATE �y OWNER -BUILDER DECLARATION I hereby affirm that 1 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) o/ 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 ($500). ❑ 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, 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.) Xcas owner of the property, am exclusively contracting with licensed contractors to con- t 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 �' -� .J 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 0 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, II shall not employ any pers n in any manner so as,to, e o e subj�te , M�the Workers' Cofrlation Laws of CaI Porn a.. ,�" Date�Owner/'�/ltJ�.��.�.�._ OTC O'A• P.LICANT: I/,!"e eG g' IFs C itdlcaPe Exemption you should eco sub%act o 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 issue (Se 3097, Civil Code.) Lender's Name A Lender's Address This is a building permit when ope'rfit d•dut, s)gn a d l atteed, and is subject to expiration it work thereunder is suspendel 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 -cf this city to enter the above-. mentioned property for inspection purposes. Signature of applicant Date Mailing Address City, State, Zip AV No. 084$4 BUILDING: TYPE CONST.,—OCC,. GRP. A.P. Number 774-22K..t1 2 Legal Description Tdit 214 Project Description 1000 retala u& wall an east Sq. Ft. Size . No. Stories No. Dw. Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ r Estimated Valuation PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. Const. 45.00 . Mech. Electrical Plumbing S.M.I. 1 Grading Driveway Enc. Infrastructure _.a,.,08-;30-90 $4 TOTAL 43,14 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 Permit Validated by: Validation: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SQ. FT. ® $ UNITS e 2ND FL. SQ. FT. a SLAB GRADE YARD SPKLR SYSTEM BONDING MOBILEHOME SVC. BAR SINK POR. SO. FT. ® STORAGE TANK FORMS GAR. SO. FT. ® POWER OUTLET ROOF DRAINS CAR P. SQ. FT. ® DUCT WORK DRAINAGE PIPING WALL SQ. FT. GAS (ROUGH) DRINKING FOUNTAIN SO FT @ URINAL ESTIMATED CONSTRUCTION VALUATION $ REINF. STEEL WATER PIPING NOTE: Not to be used as property tax valuation FLOOR DRAIN MECHANICAL FEES WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER FINAL INSP. GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED WATER SYSTEM LAUNDRY TRAY AIR HANDLING UNIT CFM $ KITCHEN SINK ABSORPTION SYSTEM B.T.U. TEMP USE PERMIT SVC WATER CLOSET' COMPRESSOR HP POLE, TEM/PERM LAVATORY HEATING SYSTEM FORCED GRAVITY AMPERES SERV ENT SHOWER BOILER B.T.U. SQ. FT. ® c BATH TUB REMARKS: SQ. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 11/. c SEWAGE DISPOSAL SQ.FT.GAR ® 3/ic HOUSE SEWER FIREPLACE 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 6 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 �A/ �� flsl✓G O / ''A� 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