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07839 (SFD)Building Owner at 4Q" P.O. BOX 1504 78-105 CALLE ESTADO LA,QUINTA, CALIFORNIA 92253 mailing Address}m1 W,lftstm ury CityZip Tel Fol.( 92533 714 -992 -OM Contractor Zip I Tel. State Lic. r / I City & Classif. / .. t n �/ Lic. # Arch., Engr., Designer Address Tel. City( Zip ( State I Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisionp-of-Chapter 9 (commencing with Section 7000) of Divi_sionn 3°of the Bussiinn . nd,Pro[f���s�s*i-on/g/Code, and my license is full f�orce.�jnd effect. i / /fHF'�:�a%� SIGNATURE A' - ° % DATE �! OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following rermitJ( (Sec. 7031.5,Business and Professions Code: Any city or county which requires a permitalo 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 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). O 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 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 contractors) licensed pursuant to the Contractor's License Law.) ❑ I 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 1TCopy 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 ($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, after making this Certificate or 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 1 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. Signature of applicant Date Mailing Address City, State, Zip No. 07839 BUILDING: TYPE CONST. OCC. GRP., A.P. Number Acacia Ham Legal Description TMCt 23268 Plat! C-3 Project Description Lot 92 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 DATEINSPECTOR Issued by: Date 5// Permit Validated by: Validation: Sq. Ft.No. Size 1927 No. Dw. Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation $105,733 PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. .352,00 Const. IRMO Mech. rl Electrical 4 Plumbing 144. so S.M.I. v Grading Driveway Enc. Infrastructure ,. S I TOTAL REMARKS • S '3.tJ �A r..kll.1 �'T �7A�.n�•t ��irr �c�ry� i•OGI + 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 DATEINSPECTOR Issued by: Date 5// Permit Validated by: Validation: CGNSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SQ. FT. ® $ UNITS COLL. AREA • ` 2ND FL. SQ. FT. ROUGH PLUMB. YARD SPKLR SYSTEM MOBILEHOME SVC. BAR SINK POR. SO. FT. ® SEWER 42 Ol ROUGH WIRING, GAR. SO. FT. ® POWER OUTLET ROOF DRAINS CAR P. I SQ. FT. GAS (ROUGH)11I qd („p DRAINAGE PIPING WALL SQ. FT. HEATING (FINAL) DRINKING FOUNTAIN. SO. FT. ® GAS (FINAL) URINAL ESTIMATED CONSTRUCTION VALUATION $ WATER PIPING NOTE: Not to be used as property tax valuation WATER HEATER FLOOR DRAIN MECHANICAL FEES FINAL INSP. WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER GRADING cu. yd. $ plus x$ GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED LAUNDRY TRAY AIR HANDLING UNIT CFM FINAL INSP. ' 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. SO. FT. RESID ® 11/4 c SEWAGE DISPOSAL SPARK ARRESTOR SQ.FT.GAR ® 3/ac HOUSE SEWER GAR. FIREWALL GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE DBL TOTAL FEESMICRO FEE FI MECH.FEE PL.CK.FEE CONST. FEE ELECT. FEE I I SMI FEE PLUMB. FEE I I I STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR SETBACK OUND PLUMBIN UNDERGROUND A.C. UNIT COLL. AREA SLAB GRADE ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMS SEWER 42 Ol ROUGH WIRING, DUCT WORK ROCK STORAGE FOUND. REINF -2 GAS (ROUGH)11I qd („p 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. ! l JQ ` D FRAMING FINAL INSP. ' ROOFING VENTILATION REMARKS: FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATIONISOUND FINISH GRADING FINAL INSPECTION VL L CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURES/INITIALS GARDEN WALL FINAL