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04903 (SFD)� ur«rw 4 �,Q P.O. BOX 1504 Building 49_ 130 QuImera Court LA QUINTA CALIFORNIA92253 Address - Owner Bas Con Development Mailing Address 68--711 Peres Road t/3 City Zip Tel Contractor Zip State Lic. I City & Classif. 337077 Lic. # 1219 Arch., Engr., Designer Address Tel. City IZip I State I Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that 1 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 r'r SIGNATURE DATE 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, after, improve, demolish, or repair any structure, prior to its issuance also requires the applicant for such permit to fits a signed statement that he is licensed pursuant to the provisions of the Contractors License Law, Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professlons 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, 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 brprovements 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 buid or improve for the purpose of safe.) ❑ 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 bu9ds or improves thereon, and who contracts for such projects with a contractors) licensed pursuant to the Contractor's License Law.) ❑ 1 am exempt under Sea R. g P.C. for this reason Date Owner WORKERS' COMPENSATION DECLARATION I hereby affirm that 1 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' COMPENSATION INSURANCE (This section need not be completed ff 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 alifornia.DateOwner NOTICE TO APPLICANT., ff, after makig rids Certificate of Exemption you should become subject to the Workers' Coapensation provisions of the Labor Code, you must forthwith comply with such proviskors 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 Lenders 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 certity 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 ateMailing Address City, State, Zip No. L•DING: TYPE CONST. 4 & OCC: GRP. P. Number Parc La Ouinta ©4903 egal Description roject Description r l ot'n 929-12, p6 a fa tb T ZONE: BY: r 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 DATEJ NS�PgCITgOg Issued by: Date 1 € Permit Validated by: Validation: Sq. Ft. 2222 Size No. 2 No. Dw. Stories - Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation 12 ,161 PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. 5 3 67. D4 Const. �%� • a u Mech. �J • �' Electrical )J:) • 1 tF Plumbing !itis • 0 S.M.I. Grading Driveway Enc. Infrastructure a �� 3,520.84 TOTAL " - ,1. ` • }-; f REMARKS 0 ZONE: BY: r 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 DATEJ NS�PgCITgOg Issued by: Date 1 € Permit Validated by: Validation: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SQ. FT. ® $ 2ND FL SQ. FT. POR. SQ. FT. ® GAR. SQ. FT. ® CAR P. I SQ. FT. WALL SQ. FT. SQ FT ® ESTIMATED CONSTRUCTION VALUATION $ UNITS MOBILEHOME SVC. POWER OUTLET YARD SPKLR SYSTEM BAR SINK ROOF DRAINS DRAINAGE PIPING DRINKING FOUNTAIN. URINAL WATER PIPING NOTE: Not to be used as property tax valuation FLOOR DRAIN MECHANICAL FEES BONDING WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTOXDISH) APPLIANCE DRYER GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED ROCK STORAGE LAUNDRY TRAY AIR HANDLING UNIT CFM GAS (ROUGH) 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 WATER HEATER SO. FT. ® c WATER HEATER MAX HEATER OUTPUT, B.T.U. SQ. FT. RESID ® 1% c SEWAGE DISPOSAL SQ.FT.GAR ® VAc HOUSE SEWER GRADING cu. yd. $ plus x$ 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 K x.16 / ROUND PLUMBINGZ `3 UNDERGROUND A.C. UNIT COLL AREA SLAB GRADE 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 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. Z( C/ FRAMING 6 1 foli FINAL INSP. ROOFING/ /(4 VENTILATION 0 e v �� /� /A V REMARKS: FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING�� MESH INSULATIONISOUND ( FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL t