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003158 (SFD)• l' Building Address 77-- its iloc. (`nll Owner Janes Laier Trust: T#1 wit 4�Q�rw P.O. BOX 1504 78-105 CALLE ESTADO LA QUINTA, CALIFORNIA 92253 Mailing Address P. Q. Box 6835 City Zip Tel. Senta Ross 1 35406 Contractor Address 53-475 Ber=Was La OuInta 1 92253 State Lic. City & Classif. I Lic. # Arcn.- tngr., Designer Address Tel. City(Zip I State Lic. # _ LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions oUchapter 9 (commencing with Section - 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. SIGNATURE - `~ +. DATE j 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 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, afitl the basis for the alleged exemption. Any violation or 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 ownemployees, provided that such improvements are not in 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 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"t__ - ❑ 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 ($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. Date s 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 sof this city to enter the above- mentioned property for inspection purposes. Signature of applicant --Date— Mailing ateMailing Address City, State, Zip No. 003158 BUILDING: TYPE CONST. . OCC. GRP. A.P. Number Legal Description Project Description s4yk1'7ir+? FA1arAII-T> x2t+fcwl�in� 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 6/16/87 Permit Validated by: Validation: HARD COPY( ` T Sq. Ft. 153 Size No. No. Dw. Stories - Units New ® Add ❑ Alter ❑. Repair ❑ Demolition ❑ Y Estimated Valuation PERMIT AMOUNT Plan Chk. Dep. $250.01D Plan Chk..Bal. $ 468.0 Const. '370.00 Mecli.. 33.40 Electrical 75.00 Plumbing 105,00 S.M.I. - 5.50 Grading 20.04 Driveway Enc. 20.00 Infrastructure 1,148.71 TOTAL $2,045.21 $$1,845.21 REMARKS .�,�,.. .,, r'e,.. .x. <+ �•, �-, 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 6/16/87 Permit Validated by: Validation: HARD COPY( ` T CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING,,FEES IST FL. SQ. FT. ® $ UNITS Ztl(,-/SLAB GRADE - Gl ieROUGH PLUMB.<j--�2r j 1 BONDING YARD SPKLR SYSTEM 2ND FL. SQ. FT. %L feFORMS � SEWER OR SEPq-F/(K &OUGH WIRING MOBILEHOME SVC. BAR SINK FOR. SQ. FT. ® GAS (ROUGH) METER LOOP GAR. SQ. FT. ® POWER OUTLET ROOF DRAINS GAS (FINAL) 4EMP. POLE 7-3G_ F DRAINAGE PIPING CAR P. SO. FT. ® GROUT WATER HEATER WALL SQ. FT. ® FINAL INSP. DRINKING FOUNTAIN SQ. FT. ® WATER SYSTEM URINAL ESTIMATED CONSTRUCTION VALUATION $ _$ WATER PIPING NOTE: Not to be used as property tax valuation FINAL INSP. �/ �� FLOOR DRAIN MECHANICAL FEES WATER SOFTENER VENT SYSTEM FAN EVAP.000L HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER 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. SQ. FT. ®c BATH TUB SQ. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 11/4 c SEWAGE DISPOSAL SQ.FT.GAR ® 3/4c 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 I PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR 2L/6ETBACK - Gt b ROUND PLUMBING7.0 UNDERGROUND A.C. UNIT COLL. AREA Ztl(,-/SLAB GRADE - Gl ieROUGH PLUMB.<j--�2r j 1 BONDING HEATING (ROUGH) STORAGE TANK %L feFORMS � SEWER OR SEPq-F/(K &OUGH WIRING DUCT WORK ROCK STORAGE FOUND. REINF. GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APP./EOUIP. �G�e-REINF. STEEL ', -;Z Of - GAS (FINAL) 4EMP. POLE 7-3G_ F GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM GRADING cu. yd. $ plus x$ _$ LUMBER GR. FINAL INSP. �/ �� FRAMING _ FINAL INSP. ? %%_ROOFING /41 _1 ?W—ROOFING i ��L%• % V ✓/ (/� (�' REMARKS: FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING / `MESH / N LATION/SOUND FINISH GRADING FINAL INSPECTION CERT. OCC. 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