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04842 (BLCK)• � ��. t 0 4 F{4 ro` 2 tis.: y P.O. BOX 1504 Building 54-165 Ramirez UINOTA Address LA QCAL FORNIA 92253 • Owner Western &wrican Const. " 'BUILDING: TYPE'CONST. ' ' OCC. GRP. Mailing Address P. 0. Box 1379 A.P. Number 774-211-020 a 021 City Zip Tel. La Ouinta 92253 564- 7411 Legal Description Contractor Y Project Description a1 t 1.P�..� na wall Address Gary _ 46 ' P. V. Box 807 CityZipPalms zip 92276 State Lic. & Classif. 469157 Arch., Engr., Designer Address 1 Lic. If 7. 14t Sq. Ft. No. Size " - - Stories el. City JZip I State Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that,l 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. �✓.r 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, alter, improve, demolish, or repair any structure, prior to its issuance also requires the applicant for such permit to rile 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 or 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 or proving that he did not build or improve for the purpose or 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 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 -insure, or a certificate of Worker's Compensation Insurance; or a certified.c6py thereof. (Sec. 3800, Labor Code.) Policy No. Company ❑ Copy is filed with the city.' O 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 (8100) 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: If, alter making this Certificate of Exemption you should become subject to the Workers' Compensation provisions or the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. New ❑ Add ❑ Alter ❑ No. Dw. Units Repair ❑ Demolition ❑ REMARKS nnir c�a'a.n I nlCa=A ia. A h11 as .+r .:. .. a ... ..,... .. ... .. ZONE: BY: Minimum Setback Distances: Front Setback from Center Line Rear Setback from Rear Prop. Line CONSTRUCTION LENDING AGENCY Side Street Setback from Center Line 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.) Side Setback from Property Line Lender's Name _ Lender's Address FINAL DATE INSPECTYR This is a building permit whenro erl filled out, signed and validated, and is subject to p �y expiration if work thereunder is suspended I for 180 days9 a ! f - I certify that I have read this application and state that the above information is correct. Issued by: Date Permit 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. Validated by: Signature of applicant Date Mailing Address Validation: City, State, Zip WHITE FINANCE PINK APPLICANT ;GREEN BUILDING GOLDENROD -'ASSESSORS OFFICE D HARCOPY - FILE yr...4'.r:.,... �,. . f1:.`r�',.t . ti.:'::'*.., �Y._,-s. ..'^sa •:+i<.a '�.. "*.sl' •�r�1. , r: z+��d_^i. ,-f,�o�,r4.� }h.:,: tf.�.._....i�:.. r*Y. _: »,t.S..:_-.. »J:z..rrx. _�'�._.4._,.:<_.r..:..::A,.+•i .. "�•: , y Estimated Valuation $2,974 PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. Const. d:3 Mech. Electrical Plumbing S.M.I. a� Grading Driveway Enc. Infrastructure TOTAL REMARKS nnir c�a'a.n I nlCa=A ia. A h11 as .+r .:. .. a ... ..,... .. ... .. ZONE: BY: Minimum Setback Distances: Front Setback from Center Line Rear Setback from Rear Prop. Line CONSTRUCTION LENDING AGENCY Side Street Setback from Center Line 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.) Side Setback from Property Line Lender's Name _ Lender's Address FINAL DATE INSPECTYR This is a building permit whenro erl filled out, signed and validated, and is subject to p �y expiration if work thereunder is suspended I for 180 days9 a ! f - I certify that I have read this application and state that the above information is correct. Issued by: Date Permit 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. Validated by: Signature of applicant Date Mailing Address Validation: City, State, Zip WHITE FINANCE PINK APPLICANT ;GREEN BUILDING GOLDENROD -'ASSESSORS OFFICE D HARCOPY - FILE yr...4'.r:.,... �,. . f1:.`r�',.t . ti.:'::'*.., �Y._,-s. ..'^sa •:+i<.a '�.. "*.sl' •�r�1. , r: z+��d_^i. ,-f,�o�,r4.� }h.:,: tf.�.._....i�:.. r*Y. _: »,t.S..:_-.. »J:z..rrx. _�'�._.4._,.:<_.r..:..::A,.+•i .. "�•: , y CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES" -1 IST FL SO F1 W $ UNITS SLAB GRADE ROUGH PLUMB BONDING YARD SPKLR SYSTEM 2ND FL SO FT. a FORMS SEWER OR SEPTIC TANK ROUGH WIRING SVC. BAR SINK POR SO FT. aMOBILEHOME GAS (ROUGH) METER LOOP HEATING (FINAL) POWER OUTLET ROOF DRAINS GAR SO. FT. (a TEMP. POLE GROUT DRAINAGE PIPING CAR P. SO FT. a FINAL INSP. OND BEAM �/ WATER SYSTEM DRINKING FOUNTAIN WALL SO. FT. (d =$ LUMBER GR. FINAL INSP. URINAL SO. FT. rat ROOFING ESTIMATED CONSTRUCTION VALUATION $ WATER PIPING NOTE: Not to be used as property tax valuation FLOOR DRAIN MECHANICAL FEES WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASH ER(AUTOHDISH) APPLIANCE DRYER FIREPLACE GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED LAUNDRYTRAY AIR HANDLING UNIT CFM 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 g I w c SEWAGE DISPOSAL SO.FT.GAR @ 3/.c HOUSE SEWER CERT. OCG GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEE MECH.FEE i'L.CK.�EE CONST. FEE ELECT. FEE SMI FEE PLUMB FEE STRUCTURE PLUMBING ELECTRICAL HEATING 8 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 APP.IEOUIP. REINF. STEEL GAS (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. OND 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. OCG FENCE FINAL INSPECTOR'S SIGNATURESlINITIALS , GARDEN WALL FINAL