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12760 (CONR)T4-tyl 4 4 Qt4 P.O. BOX 1504 Building 80-761 Cherry hills 78-105 CALLE ESTADO Address LA QUINTA, CALIFORNIA 92253 Ownerpi$. test Resic�;?£�tma1 A�50C$��.Oi1 Mailing Box 1060 I Address P.O. No. 12760 LDING: TYPE CONST. OCC: GRP. P. Number Zip Tel. Quinta, CA 92253 (619)771-1234 Legal Description C a R Western Construction A11es994 Lennon Place, Suite Al Phlm Desert, F 92264 '619)34 -8527 State Lic. City & Classif. 675573 Lic. # Arch., Engr., D.O. Adolph Designer Itt-st05 riviera T619) 771-4577 C'Uh Quanta, CAA IZip 92253 1Lict# LICENSED CONTRACTOR'S DECLARATION I hereby affirm.that I am licensed under provisions of Chapter 9 (commencing with Section 71 of Division 3 of the Business and Professions Code, and my license is in full force and effect.�� f Zi SIGNATl1RE � I� � I DATE OWNER -BUILDER DECLARATION 1 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, atter, Improve, demolish, or repair any structure, _prior to its Issuance also requires the applicant for such permit to Ole 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 penally of not more than Ove hundred dollars ($500). ❑ I, as owner;of the property, or my employees with wages.as their sole compensation, will do tlie'work,=and'the structure Is not intended or offered for sale. (Sec. 7044, Buisness and Professions Codei The Contractor's License Law does not apply to an owner of property who buadi or rinpio' thereon and who does such work himself or through his own employees, provided .lhaf 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) licensedpursuant to the Contractor's License Law.) ❑ 1 am exempt under Sec. B. 8 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 O 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 pparson In any manner so as to become subject to the Workers' Compensation Laws'of Call ornla. Date -Owner NOTICE TO APPLICANT: If, alter making this Certificate of Exemption you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with suchprovisions 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 ateMailing Address City, State, Zip Project Description Restroom Sq. Ft. 35 No. No. Dw. Size Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition.❑ r Estimated Valuation $110130.00 BY: PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal 16.25 Const. 25.00 Mech. Electrical FINAL DATE Plumbing 27. 00 S.M.I. .50 Grading Validated by: Driveway Enc. Infrastructure A f �� TOTAL • 3 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�i ropertyR�n, —I i it FINAL DATE IN PECTOl� f-Ev 7 -i`' L 4q Issued by: r. , Date �Permits.-",�� Validated by: Validation: A f �� CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SO. FT. ® $ UNITS SLAB GRADE ROUGH PLUMB. BONDING YARD SPKLR SYSTEM 2ND FL. ' SO. FT. FORMS SEWER OR SEPTIC TANK ROUGH WIRING. MOBILEHOME SVC. BAR SINK POR. S0. FT. ® GAS (ROUGH) METER LOOP GAR. SO. FT. ® POWER OUTLET ROOF DRAINS GAS (FINAL) TEMP. POLE DRAINAGE PIPING CAR P. SO. FT. GROUT WATER HEATER WALL SO. FT. FINAL INSP. DRINKING FOUNTAIN BOND BEAM WATER SYSTEM URINAL SO. FT. ® =$ LUMBER GR. ESTIMATED CONSTRUCTION VALUATION $ FINAL INSP. WATER PIPING NOTE: Not to be used ag property tax valuation FLOOR DRAIN MECHANICAL FEES WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER VENTILATION GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED FIRE ZONE ROOFING LAUNDRY TRAY AIR HANDLING UNIT CFM FIREPLACE 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. SO. FT. ® c BATH TUB SO. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 1% c SEWAGEDISPOSAL SO.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 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 APPJEOUIP. 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 INSULATION/SOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESHNITIALS GARDEN WALL FINAL