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06268 (BLCK)Building Address 77-175175 Art Owner TW�l 4 4 am P.O. BOX 1504 78-105 CALLE ESTADO LA QUINTA, CALIFORNIA 92253 Mr. &tura. Nerne Mailing Address SaM City Zip Tel. La Quints 1 92253 Contractor Owner/Builder r(V No. 06266 BUILDING: TYPE CONST. OCC: GRP._ A.P. Number Santa Ro�a£c6ile Legal Description Project Description Fence 32f X 6' higb 781 R 6' high S C (This section need not be completed N 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, B, after mating this Certificate of Exemption you should become subject to the Workers' Compensation provisions or the Labor Code, you must forthwith campy with such provisions or the Permit shag 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.) 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 certity that 1 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 ZONE: BY: 22' ,X 3- high City Zip Tela Rear Setback from Rear Prop. Line State Lic. & Classif. City Lic. # Sq. Ft. Size No. No. Dw. Stories Units Arch., Engr., ' Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Address Tel. Date Permit Validated by: City Zip State Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7M of Division 3 of the Business and Professions Code, and my license is in full force and e SIGNATURE DATE OWNER -BUILDER DECLARATION I hereby'affirm that I am exempt from the Contractor's License Law for the following reason: (Sec. 7031.5,8rsimess and Professions Code: Any city or county which requires a permit to constrict, after, improve, demofth, or repair any structure, prior to its issuance also i requires the applicant for such pemrft to fle a signed statement that hes licensed pursuant to the provi imm 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 i subjects the appicant to a civil penalty 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, Buisness and Professions Code: The Contractoes License Law does not apply to an owner of property who builds at improves thereon and who does such work himself or through his own employees, provided that such iuprovements are not intended or offered for sale. N, however, the building or improvement is said within one year of coripletion, the owner -builder wig 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 no appy to an owner of property who builds or Improves thereon, and who contracts for such projects with a contractor(s) Licensed pursuant to the Contractors License Law.) ❑ 1 am exempt under Sec B. & P.C. for this reason Estimated Valuation3 ) �� , PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. Const. $54.00 Mech. Electrical Plumbing S.M.I. .21 Grading Driveway Enc. Date owner Infrastructure WORKERS' COMPENSATION DECLARATION I hereby affirm that 1 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. ❑ Certified copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION IN URAN E TOTAL REMARKS t> � 4 % -i +o OI4tOA feed'- i� o-149 in S C (This section need not be completed N 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, B, after mating this Certificate of Exemption you should become subject to the Workers' Compensation provisions or the Labor Code, you must forthwith campy with such provisions or the Permit shag 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.) 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 certity that 1 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 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 9/12/89 Issued by: Date Permit Validated by: Validation: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES IST FL. SQ. FT. ® $ UNITS SLAB GRADE ROUGH PLUMB. BONDING YARD SPKLR SYSTEM 2ND FL. SQ. FT. @ FORMS SEWER OR SEPTIC TANK POR. SQ. FT. ® MOBILEHOME SVC. BAR SINK GAR. SQ. FT. ® POWER OUTLET ROOF DRAINS HEATING (FINAL) OTHER APPJEOUIP. DRAINAGE PIPING CAR P. SQ. FT. TEMP. POLE WALL SQ. FT. GROUT DRINKING FOUNTAIN, SQ 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 WASHER(AUTO)(DISH) APPLIANCE DRYER GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED LAUNDRYTRAY AIR HANDLING UNIT CFM VENTILATION 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 SO. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 11/4 c SEWAGE DISPOSAL 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 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 INSULATIONISOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURES/INITIALS GARDEN WALL FINAL