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09249 (PLBG)Building Address 54—Q@ Owner Mailing` Address City T.a Wt i rit;i Contractor Address State Lica - & Classif. Arch., Engr, Designer Address Zip ITO Zip Lic. # el. P.O. BOX 1504 1 78-105 CALLE ESTADO No.. LA QUINTA, CALIFORNIA 92253' �. City Zip State Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I art licensed under -provisions of Chapter 9.(commencing with Section 7000) of Division 3 oflIALBuginess and Professions Code, and my license is in full for aE and effect.. A-r,i !f SIGNATURE XGATE` OWN ER-BUILDER'DECLARATION I -hereby affirm that I am exempt from the Contractor's License Law for the following reason'(Sec. 7031.5,Suslness 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 r the:provislons of the Contractor's License Law, Chapter 9 (commencing with Section 7000)' of. bwlsion 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). . ❑.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 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- . •Stru6t 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 1 am exempt under Sec. B. & P.C. for this reason Date Owner WORKERS' COMPENSATION DECLARATION I Hereby, affirm that I have a certificate of consent to self•insuie, or a certificate of worker's++ p nsation In ur ce, or a certi Jet= gareo(.7( 800, Labor Code.) Policy N�AW4; n In.4y pany i�L tS rP plYl7 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 it 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: If, atter 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'pennitshall 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 properlyfilled 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 4w 'i. , r.� ,r ak .. r.6.•r F BUILDING: TYPE CONST. OCC: GRP. A.P. Number Legal Description Project Description Semiker Hdak Up Sq. Ft. No. No. Dw. Size Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. .Const. , Mech. Electrical ' Plumbing 30„00 S.M.I. Grading Driveway Enc. Infrastructure TOTAL 30.. Q0 REMARKS •. t:'�' '` +l�.,�.W'"r <Ci %t: 'A. �a'�i1�?w��i.:dl"A'- Y-'7 "t'Lz• .ai.,: - 'q .i - 9.V a':v YVs& , �Y;uad, . f.y.. +.!. •. )tfa �r 1Y"".. 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 COLL. AREA SLAB GRADE ROUGH PLUMB. YARD SPKLR SYSTEM 2ND FL. SQ. FT. HEATING (ROUGH) STORAGE TANK FORMS MOBILEHOME SVC. BAR SINK POR. SO. FT. ® DUCT WORK ROCKSTORAGE GAR. SQ. FT. ® POWER OUTLET ROOF DRAINS HEATING (FINAL) DRAINAGE PIPING CAR P. SQ. FT. ® GAS (FINAL) TEMP. POLE WALL SQ. FT. DRINKING FOUNTAIN. SO. FT.® WATER HEATER URINAL ESTIMATED CONSTRUCTION VALUATION $ FINAL INSP. WATER PIPING NOTE: Not to be used as property tax valuation WATER SYSTEM FLOOR DRAIN MECHANICAL FEES GRADING cu. yd. plus x$ WATER SOFTENER VENT SYSTEM FAN EVAP.000L HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER FINAL INSP. GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED �i�l��Zi✓'� Z/ / �� ell LAUNDRY TRAY AIR HANDLING UNIT CFM 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. SQ. FT. ® c BATH TUB SO. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 11/4 c SEWAGE DISPOSAL SO.FT.GAR ® 3/ac 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 ROCKSTORAGE 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 �i�l��Zi✓'� Z/ / �� ell REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATION/SOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURES11NITIALS GARDEN WALL FINAL