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9448 (BLCK)4.14 a! P.O. BOX 1504 Q. 9448 Building Address 48-48O SRN VICENTE LA QUINTA CAL FORNIA 92253'~ Owner / , TOM CARNEY BUILDING: TYPE CONST:- OCC: GRP. - Mailing Address 56-020 RIVERA A.P. Number City Zip Tel. LA QUINTA,CA 92253 Legal Description Contractor Project Description ' 3 +r X 41' BLOCK 'SCALL SAME .Address City Zip Tel.: State Lic. City & Classif. B 1 187 719 Lic. # Sq. Ft. No. No. Dw..'; ' Arch., Engr., Size - Stories Units Designer New ❑ Add ❑ Alter ❑ Repair.❑ ;Demolition .'0 Address Tel. City Zip State a; Lic. # - LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) Division 3 of the Business and Professions Code, and my license is in full force and t.of effec- ' a' 3LGNATURE DATE - ' ,• OWNER -BUILDER DECLARATION' Estimated Valuation I hereby affirm that I am exempt from the Contractor's License Law for the following $6i5 reason: (Sec. 7031.5,Business and Professions Code: Any city or • county which requires a 0GO ' permit to construct, atter, improve, demolish, or repair any structure, prior to its issuance also, requires the applicant for such permit to Bleu signed statement that he Is licensed pursuant to .- PERMIT `.V \' AMOUNT the provisions o/ the Contractor's License Law, Chapter 9 (commencing with Section 7000) of. • Division 3 o/ the Business and Professions Code, or that. he is exempt therefrom, and the basis . —for the alleged exemption. Any violation of Section 7031.5by 'any applicant for a permit - Plan Chk. Dep:. - ° subjects the applicant to a civil penalty of not more than rive hundred dollars.(8500). O'as owner of the or my employees with wages as their sole compensation, Plan Chk. Bal. property, will d'o the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and - :Professions Const. "'" ' �' , • Y2 • Q� 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, . �.- - Mech. ."''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 Electrical '•r of proving that he did not build or Improve /or the purpose o/ sale.) ❑ I, as Owner of the property,'am exclusively contracting with licensed contractors to con- • Plumbing ` struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License -Law does to ,who builds Improves • thereon, © not apply an owner o/ property or and who contracts for such projects with a contractor(s) licensed pursuant to the,Contractor.'s License Law:) r S.M.I. • + t - • , • • Grading O 1 am exempt under Sec. B. & P.C: for this reason Driveway Enc. Dateowner- �' /J-•' Infrastructure - WORKERS' COMPENSATION DECLARATION Thereby affirm that 1 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. ❑ Certified copy is hereby furnished. TOTAL • �' CERTIFICATE OF EXEMPTION FROM f WORKERS' COMPENSATION INSURANCE REMARKS - 1 r (This section need not be completed if the permit Is, Ior one hundred dollars ($100) valuation or less.) l4. , - I certify that inithe performance -of.thp work,for which this permit is issued, I shall not _ - employ any,pperson in any manner so as to become sutiject to the Workers' Compensation,/ Laws of Calltornia'r.' r y p� : `' 1 f' % ,Owner 1 :t+ �••%Ai ., 1 S X;(� f Y 4:" i i. "t3 .g..,- 10• Date t of r�t' �:�r� NOTICE iTO APPLICANT: If, after making this`Certigc'ate o/ Exemptiion you should become • s v e,ry:aa t A I G r rl" a r__f . v.; ZONE: BY: subject rfo the Workers' Compensation provisions of th� Lab-o���'r,� dGCode, you mush forthwith comply with such provisions or this permit shall be deemed rew�ked./' """^�••� ' - • Minimum Setback Distances::.;;:. Front Setback from Center Line Rear Setback from Rear Prop. Line CONSTRUCTION LENDING AGENCY Side Street Setback from Center Line Ihereby 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 Setback from Property Line " Lender's Name - - Lender's Address FINAL DATE -INSPECTOR 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 car Illy 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. Validated by: Signature of applicant Date Mailing Address Validation: City, State, Zip CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES IST FL SQ. FT. ® $ 2ND FL SQ. FT. POR. SQ. FT. ® GAR. SQ. 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 SLAB GRADE FLOOR DRAIN MECHANICAL FEES BONDING WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER ROUGH WIRING. GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED FOUND. REINF. LAUNDRY TRAY AIR HANDLING UNIT CFM, METER LOOP KITCHEN SINK ABSORPTION SYSTEM B.T.U. TEMP USE PERMIT SVC WATER CLOSET COMPRESSOR HP POLE, TEMIPERM LAVATORY HEATING SYSTEM FORCED GRAVITY 1AMPERES 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 ® 1% c SEWAGE DISPOSAL SQ.FT.GAR ® 114c HOUSE SEWER FINAL INSP. FRAMING 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 APPJEOUIP. 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 / Y] 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