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10541 (AR)44 P.O. BOX 1504 N Q . 10541 Building 78-105 CALLE ESTADO / Address 78-009 Lago Dr. LA QUINTA, CALIFORNIA 92253 Owner Mr/Mrs Donald Ar: nds BUILDING: TYPE CONST. OCC: GRP. - Mailing Address game, A.P. Number City Zip Tel. La Quinta 92253 Legal Description Contractor Project Description Enclosing part ©f atrium & Address llian, H. Fritz adding living area.. 54-550 Velasco City Zip Tel.: State Lic. City &Classif. B 5948S4 Lic. 1123 Arch., Engr., Designer Address Tel.. i 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. s 1 k ,` -t, _SIGNATURE' - DATE OWNER -BUILDER DECLARATION I hereby'afflrm that I am exempt from the Contractor's License Law for the following reason: (Sec: 7031.5,Buslness 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 suchpermitto 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 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). ?11, ❑ 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, Bulsness and ri .Professions Code: The Contractor,'s License Law does not apply to an owner of property who .:a 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.) ❑ 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.'8 P.C. for this reason Date Owner WORKERS' COMPENSATION DECLARATION I hereby affirm that I have's 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. 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, 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., It, 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 Ihereby 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 Sq. Ft. 201 Size No. Stories No. Dw. Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation 0 3-91 Si PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. 81.90 Const. 126.00 Mech. 15.00 Electrical 15.00 Plumbing S.M.I. 1.10 Grading Driveway Enc. Infrastructure TOTAL 239.00 REMARKS f\.1'..{C�_`! -A '"-'7414 !•y') �F x1 •rqi' _. �fit'1 14 l (� vyl+'r(��{.._711.-. •.-.`.VAI iYE� . ..., ( ,j I ZONE: BY: Minimum Setback Distances: Front Setback from Center Line y,Y Rear Setback from Rear Prop.'Lirie' 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 FOES " IST FL. SO. FT. ® $ 2ND FL. SO. FT. POR. SO. FT. ® GAR. SO, FT. ® CAR P. SO. FT. WALL SO. FT. ® SO FT ® ESTIMATED CONSTRUCTION VALUATION $ UNITS MOBILEHOME SVC. POWER OUTLET 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 HEATING (ROUGH) WATER SOFTENER VENT SYSTEM FAN EVAP.000L HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER DUCT WORK GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED LAUNDRY TRAY AIR HANDLING UNIT CFM METER LOOP KITCHEN SINK ABSORPTION SYSTEM B.T.U. MP USE PERMIT SVC [AMPERES; WATER CLOSET' COMPRESSOR HP LE,TEMIPERM LAVATORY HEATING SYSTEM FORCED GRAVITY 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 SEWAGE DISPOSAL =$ SO.FT.GAR ® 3/ic HOUSE SEWER FINAL INSP. FRAMING 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 FORMSmy 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. a GD ��ROOFING � 2G �� V REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL I G F ! �� MESH INSULATIONISOUND FINISH GRADING FINAL INSPECTION - CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL