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001962 (SFD)P.O. BOX 1504 No. -91962 Building 78-105 CCALIFORNIA.. 92253 Address �� 7a� San. Z�tiC.c3+8 LA QUINTA Owner Mailing Address P.O. 1580 BUILDING: TYPE CONST. OCC: GRP. rr A.P. Number r., F j "` .i % 0 0 j a Legal Description i .. �?�T ff� Project Description �1JM my MA° v City La i'• a Zip 92253 Tel. 564-6667( Contractor t tibt�f t Address _ .. City Na Qmima Zip 922653 Tel:. 564676 State Lic. City & Classif. Lic. # Sq. Ft.No. No. Dw. Size -Stories Units Arch., Engr.,' _ ' Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Address Tel. City Zip State .. . _ ... Lic. # LICENSED CONTRACTOR'S DECLARATION— I hereby affirm that I aiA 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'aKdd-,+ effect', /. - ice, f.r�� .... J7'f � � �—.. I ' /.�� 'i - / 1 d� + SIGNATURE /' r i DATE t - ' OWNER -BUILDER DECLARATION Aereby 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) o1 Division -3 of the Business and Professions Code; or tha6he 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 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.) Estimated Valuation PERMIT • .' AMOUNT z:J - Plan Chk. Dep. Plan Chk• Bal. Const - Mech. " Electrical .. Plumbing ❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-, struct the project. (Seca 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.) f7.1 am exempt under Sec. B. 8 P.C. for this reason ' S. M. I. - Grading Driveway Enc. Date Owner - Infrastructure ampilmNe Slimy g.Ut7.tiri WORKERS' COMPENSATION DECLARATION I hereby affirm that I havea *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. TOTAL 1+:3 VU CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE . . REMARKS (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 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 California. NOTICE TO APPLICANT:r If, alter 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. ZONE: BY: - Minimum Setback Distances: ' Front Setback from Center Line Rear Setback from Rear Prop. Line 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.) - Side Street Setback from Center Line Side Setback from Property Line ' Lender's Name FINAL DATE INSPECTOR 6s..T Issued by: Date 12-727—e52"�l""4J Permit by: Validation: A 3 6 3 5 12 26 .I G.R00 CK _ 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. /Validated Signature of applicantf /11- £ � j�> _Date �� Mailing Address' City, State, Zip HARD COPY CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SO. FT. ® $ 2ND FL.SO. FT. p POR. SO. FT. ® GAR. SO. FT. ® CAR P. 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 BONDING FLOOR DRAIN MECHANICAL FEES FORMS WATER SOFTENER VENT SYSTEM FAN EVAP.000L HOOD SIGN WASH ER(AUTO)(DISH) APPLIANCE DRYER GAS (ROUGH) GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED OTHER APP./EQUIP. LAUNDRYTRAY 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. 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/ac 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 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./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 FINAL INSP. ROOFING e REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR H GAR. FIREWALL LATHING MESH INSULATION/SOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL I IVJYCI:I UM "J WUNAI UMCJ/I ril I IAIJ GARDEN WALL FINAL