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002223 (SATT)4 4 Qub4 P.O. BOX 1504 Building$0,523 �n 78-105 CALLE ESTADO Address LA QUINTA, CALIFORNIA 92253 Owner Mailing Address 75--005 ClUb EV. -'Iva City I Zip Tel. Contractor Address Sam City Izip Tela State Lic. I City & Class.if. 268130 Lic. # Arch.; Engr:, Designer Address Tel. 328 CityZip State - Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby.affirm that I am licensed under provisions of Chapter 9 (commencing with Section 70 OO) of Division 3 of the Business and Professions Code, and my license is in full force'and .effect. _ "i , ' b./ SIGNATURE .It! 7 o f ", C, F s ! Z � : Y ! DATE 11 ;r 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, 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 o/.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 o/ 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.) , O 1, as owner of the property, am exclusivelycontracting 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 . Date Owner WORKERS' COMPENSATION DECLARATION 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' 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 - L 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 didinances 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 `-� ) %,°tr-' Date �( Mailing Address City, State, Zip HARD COPY N0. 002223 BUILDING: TYPE -CONST. OCC. GRP. A.P. Number. Legal Description Project Description PM WSW 21M 33 OR MrS 28.25 Sq. Ft. No. No. Dw. Size Stories - i Units New Ri Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation PERMIT Plan Chk: Dep. Plan. Chk. Bal. Const. Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure TOTAL REMARKS $ 178,3070:00 AMOUNT 5209.10 630.50 55.00 M.7 y ■ 6.50 12.36 2.000.00 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 .4-7-86 Permit Validated by: Validation: A5103 4 8 348517 CC CONSTRUCTION ESTIMATE . NO. ELECTRICAL Elft. NO. PLUMBING FEES 1ST FL. SO. FT. ® $ 2ND FL. SO. FT. POR. SO. FT. ® GAR. SO. FT. ® CARP. SO. FT. WALL SQ. FT. SO. 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 BONDING FLOOR DRAIN MECHANICAL FEES FORMSg�eSEWER WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER GAS (ROUGH) GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED OTHER APPJEOUIP. LAUNDRY TRAY AIR HANDLING UNIT CFM TEMP. POLE 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. SQ. FT. ® c BATH TUB SQ. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SQ. FT. RESID ® 11/4 c SEWAGE DISPOSAL SQ.FT.GAR ® 3/ec HOUSE SEWER REMARKS: 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 SETBACKF114.,ROUND PLUMBING:/ �� UNDERGROUND A.C. UNIT COLL. AREA J'?�,4SLAB GRADE ae ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMSg�eSEWER OR SE AIDC 0 tli�SOUGH WIRING f! U DUCT WORK ROCK STORAGE R FOUND. REINF.Lj /(�� / �T Y/ GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APPJEOUIP. REINF. STEEL GAS (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE 0114INAL INSP. ;b_/S� BOND BEAM WATER SYSTEM GRADING cu. yd. $ —Plus—X$—=$ LUMBER GR. /NAL INSP. �� �^� b1PRAMING ! Q_J&JNAL INSP./v—/j_+t t PROOFING cn REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR FIREWALL /G"AR. vr`.LATHING 8 �� MESH Jv&NSULATIONISOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL ec.K,Y3 Q -( w 7LL K,oL�I� $ P