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15775 (AR)44Q P.O. BOX 1504 B ilding 78-495 CALLE TAMPICO Address 49-826 Coachella Dr. LA QUINTA, CALIFORNIA 92253 OwnerI . & Mrs. Robert Rasmussen Mailing Address 19375 Roosevelt St. City Zip Tel. Boise/Idaho 83705 ( 3858Project Description >? Legal Description Contractor Addition/ Remodel Address 7 No. 15775 BUILDING: TYPE CONST. VII OCC. GRP, P. Number State Lic. City & Classif. Lic. # Arch., Engr., Designer Gary Wood Address Tel. 36-809 Ferber Dr. 328--4071 City Zip State Rancho Mirage 1 92270 Lic. # 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. - SIGNATURE DATE OWNEWBUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason: (Sec. 7031.5,Susiness 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) or 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, wiil 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 or 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 imprSvement is sold within one year of completion, the owner -builder will have the burden of proving that he did not build or knprove for the purpose of sale.) Vas 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 apa G' i 'r—v1 Z Owner j r_ -' a 1111%} 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. ❑ Certified copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM WORKERS'COMPENSATIONINSURANCE (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 anypparson in any manner so as to -become subject to the Workers' Compensation Laws of California.,.•" i t ;,. ,(( j ale^� �- ?Owner Lf/kj�i�i.�i�+'4.,.r^ ^NOTICE TO APPL/CANT: N, after making this 'Certificate of Exemption you should become subject to the Workers' Compensation provisions of the tabor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. This is a building permit when properly filled out, signed and validated, and is subject to expiration it 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 R3 REMARKS ZONE: BY: Minimum Setback Distances: Front Setback from Center Line Rear Setback from Rear Prop. Line Side Street Setbaa from Center Line Side Setback fc4/Ln)Pro et-ty Line FINAL DA Issued by: /PPPyite (/n�71 Permit Validated by: ,r4! Sq. Ft. 362 Size No. Stories No. Dw. Units New ❑ Addie Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation $28I,200.00 PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. $2 .0th Const. *180.70 Mech. ; 55.50 Electrical A. 33.67 Plumbing $ 51.00 S.M.I. $ 2.02 Grading $ 20.00 Driveway Enc. Infrastructure TOTAL *621.69 REMARKS ZONE: BY: Minimum Setback Distances: Front Setback from Center Line Rear Setback from Rear Prop. Line Side Street Setbaa from Center Line Side Setback fc4/Ln)Pro et-ty Line FINAL DA Issued by: /PPPyite (/n�71 Permit Validated by: ,r4! CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBINU FEES 1ST FL. SO. FT. ® $ UNITS SLAB GRADE /�� 4 ROUGH PLUMB. BONDING YARD SPKLR SYSTEM 2ND FL. SQ. FT. FORMS 1-0113 Q 13 9S SEWER OR SEPTIC TANK ROUGH WIRING SVC. BAR SINK POR. SO. FT..®MOBILEHOME GAS (ROUGH) METER LOOP GAR. SQ. FT. ® POWER OUTLET ROOF DRAINS GAS (FINAL) - TEMP. POLE DRAINAGE PIPING CAR P. SQ. FT. GROUT WATER HEATER WALL SQ. FT. FINAL INSP. DRINKING FOUNTAIN. SO. 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.COOL HOOD SIGN WASH ER(AUTO)(DISH) APPLIANCE DRYER VENTILATION GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED LAUNDRYTRAY AIR HANDLING UNIT CFM IKITCHEN 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. SO. FT. ® c BATH TUB SO. FT. ® c WATER.•. HEATER MAX. HEATER OUTPUT, B.T.U. SQ. FT. RESID ® 1+/a c SEWAGE DISPOSAL SO.FT.GAR @ 3/ac HOUSE SEWER FINISH GRADING GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEE MECH.FEE PU.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 /�� 4 ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMS 1-0113 Q 13 9S SEWER OR SEPTIC TANK ROUGH WIRING DUCT WORK ROCK STORAGE FOUND. REINF. /Q j f GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APP./EQUIP. REINF. STEEL !fj �3 9j GAS (FINAL) - TEMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM GRADING cu. yd. $ plus x$ _$ LUMBER GR. FINAL INSP. FRAMING �/H �/ FINAL INSP. ROOFING REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATION/SOUND FINISH GRADING FINAL INSPECTION lv / CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL