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09351 (RR)Building Address Owner ' u P.O. BOX 1504 78-105 CALLE ESTADO T\r LA QUINTA, CALIFORNIA 92253 yl. . No. 09351. z"I.A r4 r a= BUILDING: TYPE CONST. OCC: GRP. Mailing Address 1 arae A.P. Number City Zip Tel. T.�a ChArita 92253 Legal Description Contractor Project Description T ^1 Sa did n - Address RA Roof 82180 Verberda Ave. City Zip Tela c10 92.201 342-1141 State Lic. City & Classif. Lic. # Sq. Ft. No. No. Dw. Size Stories Units . Arch., Engr., Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ ddress Tel. City Zip State Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisipn of Chapter 9ycommencing with Section 7000 of Division 3 of the Busiriess,and Profs s Ion Code, and m license is in full force and e act.. _ C✓� SIGN TU L.y^'" DATE / OWNER -BUILDER DECLARATION f Estimated Valuation I hereby affirm that I am exempt from the Contractor's License Law for the following 5 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 - PERMIT AMOUNT 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 Any -violation Section 7031.5 by 'any for Plan Chk. Dep. alleged exemption. of applicant a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500). .Plan Bal. .❑ I, as owner of the property, or my employees with wages as their sole compensation, will .Chk. do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and Const. 1; 4. 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, Mech. 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 Electrical of proving that he did not build or improve for the purpose of sale.) O I, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing 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 contractor(s) licensed pursuant to the Contractor's License Law.) , Grading ❑ 1 am exempt under Sec. B. & P.C. for this reason Driveway Enc. Date Owner Infrastructure WORKERS' COMPENSATION DECLARATION Ihereby 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 _ 1 — p/Copy is filed with the city. ❑ Certified copy is �iereby furn�hed. C •MFiP hfa—91 ItAt - -)0,' !L` TOTAL Q _ 2 CERTIFICATE OF EXEMPTION FROM REMARKS 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 Owner NOTICE TO APPLICANT., If, after making this Certificate of Exemption you should become ZONE: BY: subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. Minimum Setback Distances: Front Setback from Center. Line 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.) 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 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: r1 T CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SQ. FT. ® $ UNITS''' COLL. AREA SLAB GRADE YARD SPKLR SYSTEM 2ND FL. SQ. FT. ® HEATING (ROUGH) STORAGE TANK POR. SQ. FT. ® MOBILEHOME SVC. BAR SINK GAR. SQ. FT. ® POWER OUTLET ROOF DRAINS FOUND. REINF. DRAINAGE PIPING CAR P. SO. FT. ® HEATING (FINAL) OTHER APPJEQUIP. WALL SQ. FT.'®' DRINKING FOUNTAIN. SQ. FT. ® 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.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER GARBAGE DISPOSAL FURNACE UNIT. WALL. FLOOR SUSPENDED FINAL INSP. LAUNDRY TRAY AIR HANDLING UNIT CFM (I' 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 FIREPLACE SQ. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SQ. FT. RESID ® IA c SEWAGE DISPOSAL SQ.FT.GAR ® V4c 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 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 ROCKSTORAGE FOUND. REINF. GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APPJEQUIP. 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. ROOFINGwy I( (I' REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATIONISOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOWS SIGNATURES)INITIALS GARDEN WALL FINAL