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003882 (OFC)4 P.O. BOX 1504 Building 78-105 CALLE ESTADO Address 51-370 Avenida EeMU has LA QUINTA, CALIFORNIA 92253 Owner Address CityZip Tel. _ Legal Description Project Description E3.F ce buildinq and City Zip Tela Palm DeSer;9226€ 773-5544 State Lic. ' City & Classif. 464843 Lic. # Arch., Engr., Designer 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. 7Z; SIGNATURE DATE • - f 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 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- 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.) 0.1. am am exempt.under Sec. B. & P.C. for this reason 1 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 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 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. Dale Owner J NOTICE TO APPLICANT., If, after making this Certificate of Exemption" you should become subjectto 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 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 it 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 HARD COPY 3timated Valuation $214,479 PERMIT Plan Chk. Dep. Plan Chk. Bal. Const. Mech. Electrical - Plumbing S.M.I. Grading Driveway Enc. Infrastructure TOTAL $3,268.63 REMARKS AMOUNT '. l � t .-, l -,NU < rl'1 .,f% A-, eN, l.. _—LI its . � 1:it.`ri 2 tilt;tt 1 •.,,•:..•,; .. ZONE: BY: Minimum Setback Distances: Front Setback from Center Line Rear Setback from Rear Prop. Line Side Street Setback from Center Line Sq. Ft., Size, • 3882 No. 2 Stories No. Dw. Units INSPECTOR Issued by: New NX Add ❑ Alter ❑ Repair ❑ Demolition ❑ 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. 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 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. Dale Owner J NOTICE TO APPLICANT., If, after making this Certificate of Exemption" you should become subjectto 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 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 it 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 HARD COPY 3timated Valuation $214,479 PERMIT Plan Chk. Dep. Plan Chk. Bal. Const. Mech. Electrical - Plumbing S.M.I. Grading Driveway Enc. Infrastructure TOTAL $3,268.63 REMARKS AMOUNT '. l � t .-, l -,NU < rl'1 .,f% A-, eN, l.. _—LI its . � 1:it.`ri 2 tilt;tt 1 •.,,•:..•,; .. 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 4/21/8t'Permit Validated by: Validation: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES IST FL. SQ. FT. ® $ UNITS SLAB GRADES , Q OU H PLUMB. A�I S� BONDING YARD SPKLR SYSTEM 2ND FL. SQ. FT. FORMS P TANK ROUGH WIRING ` / MOBILEHOME SVC. BAR SINK POR. SO. FT. ® GAS (ROUGH) METER LOOP GAR. SQ. FT. ® POWER OUTLET ROOF DRAINS CAR P. SQ. FT. TEMP. POLE DRAINAGE PIPING 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.000L HOOD SIGN WASH ER(AUTO)(DISH) APPLIANCE' DRYER GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED VENTILATION 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 SQ. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SQ. FT. RESID ® 11/4 C SEWAGE DISPOSAL SQ.FT.GAR ® 3/ac HOUSE SEWER INSULATIONISOUND 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 GRADES , Q OU H PLUMB. A�I S� BONDING HEATING (ROUGH) STORAGE TANK FORMS P 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 y / FINAL INSP. ROOFING ,Ok/ �, J ./2// I/eVei� REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR G*R:"FIREWALL LATHING MESH INSULATIONISOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS. GARDEN WALL FINAL s -j 3_4 T4t!t 4 94t& P.O. BOX 1504 APPLICATION ONLY Building S�- 3 -70,4&Z7 �r jhv,��.S78-105 LAOUINTACCAL CALIFORNIA 92253 Ar1tlrPcc Owner I WA R. 297N p ,/a 4("fa v Address iS 3tegA4 /wAO/2e WAY City Zip Tel. Contractor ii.�RY � I 1 � ffN S oN Address •z z-579 vESElZr I`gz2Z o Jciy- Ss44 State Lic. City & Classif. A'1/P,'-1 K 61 g og Lic. # Arch., Engr., Designer .(3FN A M IP IL•/� , UR/"`S Tor-) Address Tel. 3$ 4IrtZVLA r4r-vztc W^`f City Zip State 1zAr'Z410 N f I2.,G15 QyIL- 7.0 I Lic. # 2 6 3 LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 71X10) t. of Division 3 of the Business and Professions Code, and my license is in full force and effec SIGNATURE DATE OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractors 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 the 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 rive hundred dollars (11500). O 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 safe. H, 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 safe.) 0 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 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. & 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 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 the work for which this permit is issued, I shall not employ any peon in any manner so as to become subject to the Workers' Compensation Laws of Cali fornirsa. 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. 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, CIO Code.) Lenders '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 FINANCE 11LDING: TYPE CONST. `! OCC. GRP. &a2 P. Number�� �'•' ��a — t��3 !gal Description L oT r Be- dG/z 7 oject Description 1%Ci��G f .EGd _4 Sq. Ft. 3 bi� No. Size Stories I No. Dw. / Units New Add ❑ Alter ❑ Repair ❑ Demolition ❑ J Estimated Valuatio��y y7 PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. Const. O • S Mech. kZ. e7O Electrical Plumbing . 060 S.M.I. .Q Grading Driveway Enc. Infrastructure V1 A.3 TOTAL 1? 60 REMARKS 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 GROUND PLUMBING NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL.025.O SQ. FT. ® • 7 fiv SLAB GRADE UNITS BONDING HEATING (ROUGH) STORAGE TANK 0 SEWER OR SEPTIC TANK ROUGH WIRING DUCT WORK YARD SPKLR SYSTEM FOUND. REINF. 2NDFL. O SQ. FT. ® METER LOOP HEATING (FINAL) OTHER APP./EQUIP. REINF. STEEL GAS (FINAL) 1701 goa."A MOBILEHOME SVC. GROUT BAR SINK SERVICE POR. SQ. FT. ® ' BOND BEAM WATER SYSTEM GRADING CU. yd. $ plus x$ GAR. SO. FT. ® LUMBER GR. POWER OUTLET FINAL INSP. ROOF DRAINS FINAL INSP. ROOFING DRAINAGE PIPING REMARKS: CAR P. �/ SQ. FT. ® VENTILATION WALL SQ. FT. FIREPLACE DRINKING FOUNTAIN SQ. FT, ® SPARK ARRESTOR URINAL GAR. FIREWALL ESTIMATED CONSTRUCTION VALUATION LATHING WATER PIPING NOTE: Not to be used as property tax valuation MESH FLOOR DRAIN MECHANICAL FEES FINISH GRADING WATER SOFTENER VENT SYSTEM FAN EVAP.00OL HOOD - SIGN CERT. OCC.. WASH ER(AUTO)(DISH) APPLIANCE DRYER INSPECTOR'S SIGNATURESIINITIALS, GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED GARDEN WALL FINAL 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 41 FORCED GRAVITY a AMPERES SERV ENT S 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 3V SO.FT.GAR ® 3/ac s HOUSE SEWER /O GAS PIPING PERMIT FEE PERMIT FEE d PERMIT FEE - DBL TOTAL FEES MICRO FEE MECH.FEE PL.CK..FEEE CONST. FEE ELEOT. FEE SMI FEE PLUMB. FEE -5-77- 3 /5- • o 2 10,5. C% STRUCTURE PLUMBING ECE�T4iICAL' 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 APP./EQUIP. 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 SIGNATURESIINITIALS, GARDEN WALL FINAL 4A C.4 b//3� CA Z. ox� & /, / Y,:ef