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04078 (BLCK)--------------- :A! ' ' . P.O. BOX 1504 Building a�t 78-105 CALLE ESTADO Address LA QUINTA, CALIFORNIA 92253 K Owner Mailing ' r: Address. i>.',,0;' Box 1529 City- y- Zip Tel. ,Quinta 92253 - ', , Contractor w r • o ress City •z •.State Lica- & Classif. - Arcn., tngr., Designer Address , 't - City p Lic. # el. Zip (State Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) t. of Division 3 of the Business and Professions Code, and my license is in full force and effec 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,Buslness 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 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). O 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 of proving that he did not build or improve for the purpose of sale.) 0 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 contractors) licensed pursuant to the Contractor's License Law.) BUILDING: TYPE CONST.'` OCC. GRP. A.P.,Number"� . ,Legal Description ' Project Description Patio wall 60 high X 80Ir _crarden wall • Sq. Ft. No. No. Dw.: Size Stories Units ' New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation 00 PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. Const. TJ14 a 5 Mech. Electrical Plumbing S.M.I. ei Grading 0 1 am exempt under Sec. B. & P.C. for this reason : ,..._ r ✓ r• „_ Driveway Enc. Date +�--■�` ltt��`•''�"2 ! Infrastructure owner ' 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 certified copy thereof. (Sec. 3800, Labor Code.) Policy No. • Company , ❑ Copy is filed with the city. ❑ Certified copy is hereby furnished. ` TOTAL CERTIFICATE OF EXEMPTION FROM REMARKS WORKERS' COMPENSATION INSURANCE (This section need not be completed it the permit Is for one hundred dollars ($100) valuation• A�i6:.3ti*yA4r7.'r �7•�«+Fi'�t°1;t(i'� 4'r�iY�"'�"i,`�"�� •f. ' or less.) _ I certify that in the performance of the work for which this permit is Issued, I shall not employ any parson in any manner so as to become subject to the Workers' Compensation _ Laws of California. Date Owner NOTICE TO APPLICANT: 11, after making this Certificate of Exemption you should become ZONE: BY: ' subject to the Workers' Compensation provisions of the Labor Code, you must. forthwithr comply with such provisions or this permit shall be deemed revoked. - - Minimum Setback Distances: - _ Front Setback from Center Line ' r Rear Setback from Rear Prop. Line, - CONSTRUCTION LENDING AGENCY " Side Street Setback from Center Line ., 1 hereby affirm that there is a construction lending agency for the performance of the: . work for which this permit is issued. (Sec. 3097, Civil S - - ' Side Setback from Property Line ' _Code.). Lender's Name ' . Lender's Address FINAL DATE i a INSPECTOR . This Is a building permit when properly filled out, signed and validated, and Is subject to' -'4 d - expiration It work thereunder is suspended for 180 days. - i5 I certify that I have read this application and state that the above information is correct. Issued by: - Date Permit • - 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. r Validated by: Signature of applicant " Dale 3 Mailing Address Validation: tCity,'State; Zip' ` >v , WHITE FINANCE PINK APPLICANT;' GREEN BUILDING,' GOLDENROD ASSESSORS OFFICE HARD COPY,- FILE } ,'1...:j, �7�hKf•F's'6 ,• i;t '..,' t , .-.5 _.; ..j5. .j.. -t.`r' _s�'..r ti._. k, gid, /, .... ,_, i,, r.. e. .._'+�'. ,., ....kr .:._ T'�r3.w.s .,5 .. i;>J n CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES ISI FL SO FT !p S UNITS SLAB GRADE ROUGH PLUMB BONDING YARD SPKLR SYSTEM 2ND FL SO FT. @ FORMS SEWER OR SEPTIC TANK ROUGH WIRING MOBILEHOME SVC. BAR SINK POR SO FT a GAS (ROUGH) METER LOOP HEATING (FINAL) POWER OUTLET ROOF DRAINS GAR SO. FT. fr TEMP. POLE . GROUT DRAINAGE PIPING CAR P. SO FT. a FINAL INSP. WALL SO. FT. @ WATER SYSTEM DRINKING FOUNTAIN GRADING cu. yd. S plus xS =$ URINAL SO. FT. d FINAL INSP. FRAMING 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(AUTONDISHI APPLIANCE DRYER FIRE ZONE ROOFING GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED • FIREPLACE LAUNDRYTRAY AIR HANDLING UNIT CFM 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. g c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID g 1 V: c SEWAGE DISPOSAL SQ.FT.GAR rg 34c HOUSE SEWER FINAL INSPECTION GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE DBL TOTAL FEES I. 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.G 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 xS =$ LUMBER GR. FINAL INSP. FRAMING FINAL INSP. ROOFING REMARKS: VENTILATION FIRE ZONE ROOFING • FIREPLACE SPARK ARRESTOR - GAR. FIREWALL LATHING MESH INSULATIONISOUND• FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS _ GARDEN WALL FINAL 7d