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12708 (AR)dri Adddressss ' 46-r555 Camera Palms Owner Judy V©soler-Woodard Mailing same Address cityLa zip Tel. Quinta p C k .92253 I Contractor r=;::—Al Durrett ' Address P.O. Pax 3371 cityPalmDeserti, '8A 92251 Tel.' • State Lic. City & Classif. Lic. # P.O. BOX 1504 78-105 CALLE ESTADO LA QUINTA, CALIFORNIA 92253 5614--36173 Arch., Engr., Pani Scott Andersen t AIA Designer Address Tel. . P.O. Box 277 564-65038 City Quinta, C:Z1p 9223 St Licto C--1$179 r 1 LICENSED CONTRACTOR'S DECLARATION/,-/ ' I hereby affirm that 1,5m licensed under provisions of Chapter 9 (rcommencing,with„Section 0' 7000) of, Div 'on 3 oofft'he Business and Professions Code, and myai6ense is in full force ands 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 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 orimprovement is sold within one year of completion, the owner -builder will have the burden ” i of 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.) ❑ 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 O Copy is filed with the city. O Certified copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCEf� (This section need not be completed i/ the%permit is for -one hundred dollars ($100) valuation or less. I certify that igAhe performance of thg work„for"w,.hich this permit is issued, I shall not mploy any person in any�nanner so as to become subject to the Workers' Compensation aws of -California:'! f Date—• Owner - NOTICE TO sAPPLfCANT: ,Ref>making this Certificate -'o/ Exemption you should become subject to the Workers' Compensation provisions of the Labor Code, yqu 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 ordinances and state laws relating to building construction, and hereby authorize representatives -of this city to enter the above-, mentioned property for inspection purposes. Jr Signature of applicant Date Mailing Address City, State, Zip No. BUILDING: TYPE CONST. OCC: GRP.: A.P. Number 617--051-007 Legal Description Project Description Root Addition 1270© Sq. Ft. 13>r? Size No. No. Dw. Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation V f 113.00 PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. 64.35 Const. 99.00 -Mech. 21.00 Electrical 19.76 Plumbing ', 1 S.M.I. .71 Grading Driveway Enc. Infrastructure TOTAL 204.82 REMARKS ` t i Ul jl EEB22 ZONE: BY: Minimum Setback Distances:(� Front Setback from Centeb Line - 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: 1994 v CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SO. FT. ® $ UNITS SLAB GRADE 1/ } n i ` r BONDING YARD SPKLR SYSTEM 2ND FL. `' SO. FT. @ FORMS SEWER OR SEPTIC TANK ROUGH WIRING MOBILEHOME SVC. BAR SINK FOR. SQ. FT. ® GAS (ROUGH) METER LOOP GAR. SQ. FT. @ POWER OUTLET ROOF DRAINS GAS (FINAL) ' DRAINAGE PIPING CAR P. Q. FT. GROUT WATER HEATER WALL SQ. FT. FINAL INSP. DRINKING FOUNTAIN SQ. 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 GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED LAUNDRYTRAY AIR HANDLING UNIT CFM FIRE ZONE ROOFING - 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 LATHING SQ. FT. @ c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SQ. FT. RESID @ 11/4 c SEWAGE DISPOSAL SQ.FT.GAR @ 3/ac HOUSE SEWER GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEE MECH.FEE LE 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 1/ 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./EQUIP. 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 3 / FINAL INSP. rg�( ROOFING 3-7 q `ja trr� REMARKS: VENTILATION FIRE ZONE ROOFING - FIREPLACE SPARK ARRESTOR GAR. FIREWALL3ay� LATHING MESH INSULATION/SOUND FINISH GRADING ,/ FINAL INSPECTION/ —'�;-T «c CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL