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03922 (AR)P.O. BOX 1504 Building �„��� �,aLt3lJ P 78-105 CALLE ESTADO Address LA QUINTA, CALIFORNIA 92253. Owner 3,922 n. Rector BUILDING: TYPE CONST. OCC. GRP. A.P. Number 517--052--005 Legal Description Description " iiir-mit + 003782 --Added -to -Floor -plan Mailing Address " City Tel. l-' ContractorProject Household Construction Address f� y {y 43-780 Colob�»a tans .. CityZip �►r�m da r mnip 9220 Tel.� Plan Chk. Dep. State Lic. & Classif. City 11�� Lic. # Sq. Ft. 77 No. " ' ' No. Dw. Size Stories Units Arch., Engr., Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Address Tel. Electrical City Zip State 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.. t r' s - ••• r X 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, 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 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'an'd 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 or 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 a contractor(s) licensed pursuant to the Contractor's License Law.) Q 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 ❑ Copy is filed with the city. ❑ Certified copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed it the permit is for one hundred dollars ($100) valuation or less.) I certify that in the performance of thg 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 Cafornia.-• 1 Date :1.- �OwnerL ;13r�jr+r , �, i f NOTICE TO APPLICANT: It, 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 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 1 WHITE - FINANCE, PINK - APPLICANT, GREEN - BUILDING, GOLDENROD - ASSESSOR'S OFFICE, HARD COPY - FILE Estimated Valuation PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. s? a Const. 44 • tAU Mech. Electrical Plumbing S.M.I. . 5 Grading Driveway Enc. Infrastructure TOTAL REMARKS �nrx:1?n a!! rriet.i. rc:_,no�an � 1 IiJ L11,lft 3 lUiFii, t �.3,'r'i 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 IIN� P�C�TOR Issued by: Date Permit Validated by: Validation: 1 WHITE - FINANCE, PINK - APPLICANT, GREEN - BUILDING, GOLDENROD - ASSESSOR'S OFFICE, HARD COPY - FILE CONSTRUCTION ESTIMATL NO. ELECTRICAL FEES NO. PLUMBING FEES A.C. UNIT COLL. AREA SLAB GRADE IST FL SO FT la S UNITS HEATING (ROUGH) STORAGE TANK FORMS YARD SPKLR SYSTEM 2ND FL SO FT. 6 DUCT WORK ROCK STORAGE FOUND. REINF. MOBILEHOME SVC. BAR SINK POR SO FT. at OTHER APP.IEOUIP. REINF. STEEL GAS (FINAL) POWER OUTLET DRAINS GAR SO. FT. QF GROUT IROOF SERVICE FINAL INSP. DRAINAGE PIPING CAR P. SO FT. ra WATER SYSTEM WALL SO. FT. (a =E DRINKING FOUNTAIN FINAL INSP. URINAL SO FT d ROOFING ESTIMATED CONSTRUCTION VALUATION S WATER PIPING NOTE: Not to be used as property tax valuation FLOOR DRAIN MECHANICAL FEES WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTONDISH) APPLIANCE DRYER FIREPLACE GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED LAUNDRVTRAY AIR HANDLING UNIT CFM IKITCHEN 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. SO. FT. c BATH TUB SO. FT. c WATER HEATER MAX. HEATER OUTPUT, B.T,U. SO. FT. RESID 1'A c SEWAGE DISPOSAL SO.FT.GAR @ ji c HOUSE SEWER CERT. OCC. 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 8 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 ROCK STORAGE FOUND. REINF. GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APP.IEOUIP. REINF. STEEL GAS (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM GRADING cu. yd. S plus -x$ =E LUMBER GR. FINAL INSP. FRAMING FINAL INSP. ROOFING REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR - GAR. FIREWALL LATHING MESH INSULATION/SOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESlINITIALS GARDEN WALL FINAL Desert Sands Unified School District CERTIFICATION OF PAYMENT OF SCHOOL FACILITY FEES TO: City of La Quinta Department of Community 78-105 Calle Estado La Quinta, CA 92253 DATE: Development (U4 _ t� NOTICE: THIS DOCUMENT CAMa110T BE DUPLICATED. This is to cert y that developer of ,1 located at — t.his District, has paid school acility fee authority generated by Government C de Sect $ 11 S. 3"© ( kAA� covering a total of square ( ) industrial/commercial development and this footage in this development may now be „e-� , which is !�L j4jnXz %1(f within s imposed pursuant to the ion 53080 in the amount of feet of (Y�residential or that building permits for issued by your jurisdiction. for DESE T SANDS•UNIFIED SCHOOL DISTRICT White - Building Department • Yellow - Facilities Planning • Pink - Accounting • Gold - Developer 0007