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06497 (SFD)i P.O. BOX 1504 Building 73-615 Bottlebrash `LA QUINTA, CALIFORNIA8-105 CALLE p 92253 DO Address . Owner TOTa Yarn _ y Mailing Address City Zip 7�17 �_ Contractor Sal= Address , City Zip Tel.: State Lic. City & Classif. 450429 Lic. # 954 Arch., Engr., Designer Address Tel. City I Zip I State Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of.DWision 3 off the Business and Professions Code, and my license is in full force -and effect/>� �. . L� ��._. _ %r 4 . ? �,� ' Z E ( SIGNATURE DATE OWNEWBUILDER DECLARATION I hereby affilyn that 1 am exempt from the Contractor's License Law for the following reason: (Sec. 7031.5,18usiness and Professions Code: Any city or county which requires a permit to construct, after, 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 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 cin? penatty of not more than rive hundred dollars ($500). ❑ 1, 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 Comractor's License Law does not apply to -an owner of property who builds or onproves thereon and who does such work himself or'through his own employees, provided that such improvements are not intended or offered for sale. lf, 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 of sale.) 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 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 Workers Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.) Policy No Company 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 if the permit is for one hundred dollars ($100) valuation or less.) 1 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: lf, 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.) Lenders Name Lender's Address This is abuilding 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 No. 06497 WILDING: TYPE CONST. OCC. GRP. k.P. Number 627«-382-021 _egal Description >roject Description Si ZONE: BY: Minimum Setback Distances: Front Setback from Center Line Sq. Ft. 1540 Size No. "' Stories No. Dw. Units' New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ FINAL DATE I� spiCTOR� a Issued by: Date Permit Validated by: Validation: Estimated Valuation $88,10 PERMIT AMOUNT Plan Chk. Dep. $250.00 Plan Chk. Bal. $ 249.23 Const. 585.50 Mech. 53.50 Electrical 111.40 Plumbing 157.50 S.M.I. 6.16 Grading 2t1.00 Driveway Enc. 20.06 Infrastructure 11204420-00 Fri —Toad Lizg ird 63.88 TOTAL3s.. 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 I� spiCTOR� a Issued by: Date Permit Validated by: Validation: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SO. FT. @ $ UNITS SLAB GRADE �� /6 2ND FL. SO. FT. @ BONDING YARD SPKLR SYSTEM STORAGE TANK MOBILEHOME SVC. BAR SINK POR: SO. FT. @ DUCT WORK ROCK STORAGE GAR. SO. FT, @ POWER OUTLET ROOF DRAINS HEATING (FINAL) OTHER APPJEOUIP. DRAINAGE PIPING CAR P. SD. FT. @ TEMP. POLE A116ALf WALL SO. FT. @ GROUT DRINKING FOUNTAIN SO. FT. @ FINAL INSP. URINAL ESTIMATED CONSTRUCTION VALUATION $ WATER SYSTEM FINAL INSP.$ WATER PIPING NOTE: Not to be used as property tax valuation _$ FLOOR DRAIN MECHANICAL FEES ROOFING�/,//� �'�� 90 _''''_ WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED 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 SO. FT. @ c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID @ 11/4 c SEWAGE DISPOSAL SO.FT.GAR @ V4c HOUSE SEWER FINISH GRADING 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 ROUND PLUMBINGi�� UNDERGROUND A.C. UNIT COLL. AREA SLAB GRADE �� /6 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 APPJEOUIP. REINF. STEEL GAS (FINAL) TEMP. POLE A116ALf GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM FINAL INSP.$ FINAL INSP. 7 GRADING cu. yd. plus X$ _$ LUMBER GR. FRAMING O ROOFING�/,//� �'�� 90 _''''_ r�� J/Ji �p�Q� tj Q 6 REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATIONISOUND FINISH GRADING 1 FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURES/INITIALS GARDEN WALL FINAL 1 P.O. Box 1504 APPLICATION ONLY Building //_ ,�A 81(15 CALLE ESTADO Address - 1p�S %�«vLA OUINTA, CALIFORNIA 92253 Owner .. - w� Mailing - A.P. Number6/ 2, citv Zip Tel. .•� Legal Descriptio 11 1 JkS4--1_t �� t?� Li'l aN64�A. tJ4 Contract rh Project Description„ i .�► lE �Ci. �.,' (/ of t� ��`� e. to, fir �r Address P,,ry Jzip,Tel..Uf�� r1 State Lic. t. City. & Classif. �T2-a., Lic. S Sq. Ft. No. No. DW. ' Arch., Engr., Size 4 D Stories Units us Designer /` �� Newt] Add ❑ Alter ❑ Repair ❑ -Demolition ❑ Addres v. 14 r—L.��2lf , o ck Tel. C' Fipq State pps Pl-1- t2 6 o Lic. # _ LICENSED CONTRACTOR'S DECLARATION 1 her affirm that I am licensed under provisions of Chapter 9 (commencing with Section e7littOfn Ilion 3 ol.th� Busirress and Professions Code, and my liken is I4fua f nw �(O • SIGNAWFfE IATE OWNEWBUILDER DECLARATION Estimated Valuation I hereby affirm that I am exempt from the Contractor's License Law for the following reason: (Sec. 7031.50ishess and professions Code: Any c9y or county ~ requires-a permit to construct. ager, irprove, demolish, or repab any structure. prior to its Issuance abro . requires rhe appltcad for such permf to Me a sVW ststement diet he is licensed pursuant ro . PERMIT . -. _ _ :. _ .. _ AMOUNT the provfabm W the Contractors l.Acense Lar, Chapter 9 (commar ing with Section 7000) of DMsbn 3 of the Bus/ness and Pmfessbns Cade, or Met. he Is exempt fherehom, and the bast& for the alteped axenpdan. Any vbWbn of section 7031.5--by -any a p➢caiN -for. a .pemw -- . _. Plan-Ghkr Dep:-----c-o &toads the applicant to a dM penalty of rat more than nve hundred da8as (6500)• ❑ 1. as owner of the property,. or my employees with wages as their.sole compensation .will.,,_ Plan Chk. Bal. - do the work, and the structure is not intended or offered for sale. (Sec. 7044, &Amess and Professbns Cade: The CmtradWe License Law does not apply to an owner of property who- �• Const. builds or hproves thereon and who dam-such work hiiself or through hb-own.amptyms....m: provided that such hpovements are nor bdended or offered for sate. I, -however, the-buk(Ing a -= or hprovemernt Is sale with one year of cor ph tion, the owner=burl er� wY have Me burden�+ � €Electrical ' ' - _ • "' •f . . of proving that he cW not builder kuhprove, for the purpose of sale:)- - ?. r.._. ....."......,,,...:..,.._ _ .�. .. ❑ 1, as owner of the property, am exclusively contracting with licensed contractors to con.. a , :� Plumbing , .�• struct..the project (Sec. 70_�I,.Busbass.and Professions Code: The.Contradoes License law does not apply to an owner of property who builds or hproves Me em: and_who such projects wilh a contractor(s) tbensed pursuant to Me Contractor's License Law:) • ...._ . ' . `uim exempt uniaer Sei - - R - - -- _ grading ❑'1 D 3 V.C. for thin[•- Driveway Enc. Date owner Infrastructure, p7 WORKERS' COMPENSATION DECLARATION Zl r f (, - TO _ u kr- 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 conpany ❑ Copy is filed with the city. ❑ Certified copy is hereby fumished. TOTAL CxD CERTIFICATE OF EXEMPTION FROM REMARKS ,, , r._ oo n WORKERS' COMPENSATION INSURANCE ^ irt} 9r% 09 26 - (This sewn need not be completed ff Me pew* b for one hum ed dolts& (S 100) vakinden or less.) f:ACN 1 TOTAL i-•275:00 - - 1 certify that In the performance of the work for which this permit Is Issued: I shall not _ _ •_ - t' >� Laws f �Ilfornla in any manner so as to become subject to the Workers' Compensation T a - Da iroTlce To AppucQ"`�rr, efts. makrny Mls Cembare of Exemption you should Nermne ZONE BY: "". ".� s+Act leto the VAx*era' Corrpensatbn provisions o/ Me Labor Code, you must forthwMw n •:ry campy,lischprovRsfarns orhit Pam* shaobedeemed revoked. Minimum Setback Distances: Front Setback from Center Line Rear Setback from Rear Prop. Line CONSTRUCTION LENDING AGENCY Side Street'Setback from Center Line that work fwch th perrnR srissued (Sec. 097, Is a construction lCW ending C�aAerny for the performanceofthe Side Setback from Property Line Lender's Name Lender': Address This is a building permit when property filled out, signed and validated, and is subject to FINAL DATE INSPECTOR expiration It work thereunder is suspended for 160 days. 1 certity 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 lir tinned end hereby au htxtre representatives of this city to enter the above. propery far inspection purposes. Validated by: Signature of applicant— Date ` Mailing Address Validation: city, state, Zip