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002813 (SFD)P.O. BOX 1504 ' No. 002813 Building 7&105 CALLE ESTADO Address 52'1 ALdft BennUs LA QUINTA, CALIFORNIA 92253 Owner Mailing Address. CityZip � Tel. Contractor Sts= CX�at�3t�7Q: State Address SIMM - City >`CIM Zip Tela State Lic. & Classif. 307934 City Lic. # Arch., Engr., - Designer SIGNATURE - DATE Address Tel. BUILDING: TYPE CONST. OCC: GRP. A.P. Number 773-315"'012 Legal Description lot 6 Project Description simle famu'Y d%mU lm ] 1410 � 1W Pt '7N5 Sq. Ft. No. o. Dw. Size CSR 428- -Stories Units New C*, 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. .O Certified copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed i1 the permit is for one hundred dollars ($100) valuation or less.) i 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, 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, 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. r� Signature of applicant 4—' Date 4 �"• Mailing Address € City, State, Zip f ' HARD COPY TOTAL REMARKS 1 AMOUNT 3 X56.20 358.00 +30.00 74.22 99.00 5.22 20.00? ^20.00 1 tr 093 . 914 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 12 -3G -BB ermit Validated by: Validation: aio2o 12 31 ;.76.46 gl City Zip State _ - 1Lic.# 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. .'l:. -! %� r'M "r✓ ek _• SIGNATURE - DATE 1/ 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 file a signed statement that he is licensed pursuant to Estimated Valuation I PERMIT. the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of Plan Chk. Dep. 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 Plan Chk. Bal. Const. < 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 Mech. 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 Electrical 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.) - Plumbing O 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 S.M.I. such projects with a contractors) licensed pursuant to the Contractor's License Law.) 0 1 am exempt under Sec. B. & P.C. for this reason Grading Driveway Enc. Date owner 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. .O Certified copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed i1 the permit is for one hundred dollars ($100) valuation or less.) i 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, 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, 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. r� Signature of applicant 4—' Date 4 �"• Mailing Address € City, State, Zip f ' HARD COPY TOTAL REMARKS 1 AMOUNT 3 X56.20 358.00 +30.00 74.22 99.00 5.22 20.00? ^20.00 1 tr 093 . 914 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 12 -3G -BB ermit Validated by: Validation: aio2o 12 31 ;.76.46 gl CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SQ. FT. ® $ UNITS COLL. AREA SLAB GRADE ( LOUGH PLUMB. 2 " i,,S? YARD SPKLR SYSTEM 2ND FL. SQ. FT. ® HEATING (ROUGH) STORAGE TANK FORMSEWER MOBILEHOME SVC. BAR SINK POR. SQ. FT. ® DUCT WORK ROCKSTORAGE GAR. SQ. FT. ® POWER OUTLET ROOF DRAINS CAR P. SQ. FT. ® HEATING (FINAL) DRAINAGE PIPING WALL SQ. FT. GAS (FINAL) DRINKING FOUNTAIN SO FT ® URINAL ESTIMATED CONSTRUCTION VALUATION $ WATER HEATER WATER PIPING NOTE: Not to be used as property tax valuation NAL INSP.G/—k FLOOR DRAIN MECHANICAL FEES WATER SYSTEM WATER SOFTENER VENT SYSTEM FAN EVAP.000L HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER NAL INSP. T --s—a ) GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED ,iv"OOFING 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. SO. FT. ® c BATH TUB SQ. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SQ. FT. RESID ® 1% c SEWAGE DISPOSAL SQ.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 rL OUND PLUMBING I A UNDERGROUND A.C. UNIT COLL. AREA SLAB GRADE ( LOUGH PLUMB. 2 " i,,S? BONDING HEATING (ROUGH) STORAGE TANK FORMSEWER OR SEPTI /LAOUGH WIRING '�� DUCT WORK ROCKSTORAGE OUND. REINF. a v GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APP.IEQUIP. REINF. STEEL GAS (FINAL) f�OMP. POLE GROUT WATER HEATER SERVICE NAL INSP.G/—k BOND BEAM WATER SYSTEM $ GRADING cu. yd. plus x$ _$ LUMBER GR. NAL INSP. T --s—a ) �{LFRAMING NAL INSP.4 ,. —� 1 ,iv"OOFING �� e�-r ��� p %LLL c/ 3//C �T e� REMARKS: VVLL VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING 3 SH ULATIONISOUND z� FINISH GRADING / 9(46INAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURES/INITIALS GARDEN WALL FINAL