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11552 (AR)44 41 P.O. BOX 1504 N o . Building 46-SjW HIGHLAND PASMS LA QUINTA CALIFORNIA 92253 (� + Address 11552 Owner r' NEWELL AND HELEN ACKERSON BUILDING: TYPE CONST. OCC: GRP. Mailing Address P. 0. BOX 685 A.P. Number CityZip Tel. LA. QUINTA 92253 Legal Description Project Description BATH ADDITION AND PATIO ENCLOSURE (ROOM ADDITION AND CARPORT Contractor E. J. PETERSON COB�STSBCCION Address'. City DESERT ROT Zip' 022/40 SP Nr.. Tel.: ' State Lic. & Classif. City Lic. # 804M ADD. 373.S.Q"FT'.:� ' Sq. Ft. Floc c No. Dw. Size" CARPORT . 2 b°foriON., 'F3` ': -:Units Arch., Engr., - Designer New O 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) of Division 3 of the Business and Professions Code, and my license is in full force and effect. t - 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,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 that. he Is exempt therefrom,- and the basis for the alleged exemption. Any violation or Section 7031:5 by 'any applicant for a permit subjects the applicant to a civil penalty of not more than rivehundred 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 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 burdenElectrical or 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.) - O I am exempt under Sec. B. 8 P.C. for this reason ' Estimated Valuation CARPORT 43 919 Z AT T 1 7 C C1 !► _ _n7 PERMIT ' ' �t f ' AMOUNT - -, Plan Chk. Dep. , r Plan Chk. BBI. $152.00 Const. + 234.00 Mech. + 2(i .0O 0 , p 1 4+ w LFV Plumbing 39.00 S.M.I. Grading - Driveway -Enc. - Date °/ ownerf t'='"'-f"�-a.r, t✓ Infrastructure 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. .❑ Certified copy is hereby furnished. + TOTAL $+478. CERTIFICATE OF EXEMPTION FROM - WORKERS' COMPENSATION INSURANCE. REMARKS (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, I shall not, employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. i h �itt 2 _�"•a t'}.r : 7ji1'C/f - '?Y7LT - �i. 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. ZONE: BY: Minimum Setback Distances: Front Setback from Center Line 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 Rear Setback from Rear Prop. Line_ Side Street Setback from Center Line Side Setback from Property Line 5 - FINAL DATE INSPECTOR Issued by: Date Permit Validated by: r Validation: CONSTRUCTION ESTIMATE 1ST FL. SQ. FT. ® $ 2ND FL. SQ. FT. FOR. SQ. FT. ® GAR. SQ. FT. ® CARP. SQ. FT. WALL SQ. FT. SQ FT ® ESTIMATED CONSTRUCTION VALUATION $ NO. ELECTRICAL FEES UNITS MOBILEHOME SVC. POWER OUTLET NO. PLUMBING FEES YARD SPKLR SYSTEM BAR SINK ROOF DRAINS DRAINAGE PIPING DRINKING FOUNTAIN, URINAL WATER PIPING NOTE: Not to be used as property tax valuation FLOOR DRAIN MECHANICAL FEES WATER SOFTENER VENT SYSTEM FAN EVAP.000L HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER GROUND PLUMBING �! GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED LAUNDRY TRAY AIR HANDLING UNIT CFM SLAB GRADE 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 ROCK STORAGE SQ. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 11/. c SEWAGE DISPOSAL SO.FT.GAR ® Vic HOUSE SEWER GAS (FINAL) TEMP. POLE 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 too SETBACK GROUND PLUMBING �! NDERGROUND 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 LUMBER GR. FINAL INSP.— cu. yd. $ plus x$ =$ FRAMING ! ��Q G� [[[[ FINAL INSP. ROOFING REMARKS: ion fo C w VENTILATION Cw,A OV FIRE ZONE ROOFING ctN C f/—. O FIREPLACE SPARK ARRESTOR ^ GAR. FIREWALL — LATHING�lQ �� =/ p� II mT KkrI 3-1/-1-3 L o r.CC 9✓► l MESH INSULATION/SOUND:-r i� %%�Ytit1 +t FINISH GRADING FINAL INSPECTION01 / LAI rn . CERT. OCC. a� 171.e -1 S c-1 , ^ d °' FENCE FINAL INSPECTOR'S SIGNATURES/INITIALS GARDEN WALL FINAL ....... . 0/ _ . �.. _.._.__ __ :. ;c _�� �... . . ........ _ ___ _ _ _ __ _ _ _ _ __ _ _____ ___ ce, I I ------- ---- I 8 �2 If 2 - ----'--------- --- ` H `������ - �------ )- '- ' --------------'�---- ` --------'-~-` ^�', ' ' '--'------- �� '---- ------ � �-'- / - -- T71 . . .