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10639 (BLCK)tluGv .4 c: r..' P.O. BOX 1504 Building78-105 CALLE ESTADO Address 78 -545 --SAGEBRUSH LA QUINTA;,CALIFORNIA 92253 Owner y BOB GRIMES Mailing Address 77-38d EVENING STRR CIRCLE City Zip Tel. INDIAN WE LS 92210 1 Contractor OVNER BUILDER Address City State Lic. I City & Classif. Lic. # Arch., Engr., Designer Address Tel. 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 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 Ole 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 permft subjects the applicant to a civil penalty of not more than Ove 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 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.) . CI, 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 whocontractsfor such projects with a contractor(s) licensed(pursuant to the Contractor's License Law.) ❑ 1 a exempt under Sec. 1B%& P.0\for this reason ' Date WORKERS' COMPENSATION DECLARATION I hereby affirm that'l have a certificate of'consent to self -insure, or a certificate of Worker's Compensation Insurance, or a certifiedicopy thereof. (Sec. 3800, Labor Code.) Policy -No. Company LiCopy is filed with the city. ❑ Certified S• bl, copyis hereby furnished. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars (8100) 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 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 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. Signature of applicant Date Mailing Address City, State, Zip No. 10639 BUILDING: TYPE CONST. OCC: GRP.- A.P. Number Legal Description Proiect Description POOL .AND .SPA ZONE: BY: Minimum Setback Distances: Sq. Ft. Size No. No. Dw. Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Side Street Setback from Center Line Side Setback from Property Line FINAL DATE INSPECTOR Issued by: Date Permit Validated by: Estimated. Valuation $14 000 PERMIT AMOUNT Plan Chk: Dep`: '� r Plan Chk. Bal. $99.43 Const. 153.00 Mech. 24.00 Electrical 45.00 Plumbing 27'.00 S.M.I: 1.40 Grading Driveway Enc. Infrastructure t,$c'i•q�qt, {^ 4(A kA471; Irt 77j� 1, tJ AS i i_t 3 i'�i+r L .xiY t r3iS TOTAL 5349'-• g REMARKS 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 Permit Validated by: Validation: N CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FLAWS 1ST FL. SQ. FT. ® $ 2ND FL. SQ. FT. ® POR. SQ. FT. ® GAR. SQ. FT. ® CAR P. SO. FT. ® WALL SO. FT. ® SQ. FT. ® ESTIMATED CONSTRUCTION VALUATION $ UNITS r 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 FORMS WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER GAS (ROUGH0? ( GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED OTHER APPJEQUIP. LAUNDRY TRAY AIR HANDLING UNIT CFM TEMP. POLE 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. SO. FT. ® c BATH TUB SQ. FT. ® c WATER HEATER. MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 11/. c SEWAGE DISPOSAL SO.FT.GAR ® VAc HOUSE SEWER VENTILATION 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 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 (ROUGH0? ( METER LOOP HEATING (FINAL) OTHER APPJEQUIP. REINF. STEEL GAS (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE FINAL INSP, BOND BEAM WATER SYSTEM FINAL INSP. GRADING cu. yd. $ plus x$ =$ LUMBER GR. 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 SIGNATURESIINITIALS GARDEN WALL FINAL