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001614 (SATT)P.O. BOX 1504 Building 78-105 CALLE ESTADO Address LA QUINTA, CALIFORNIA 92253 Owner Mailing Address City I Zip ITel. ress Sam ty lZip State Lic.I city & Classif. Lic. # Arch., Engr., Designer 1 Address Tel. 2915 Aad Ali A91B. - PUF 71.4-540"5117 City Zip State nwe-•tr Lic. # - _ LICENSED CONTRACTOR'S DECLARATION ~ I hereby affirm that I arr 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. y SIGNATURE - 'i DATE OWNER -BUILDER DECLARATION I hereby affirm that;1 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, atter, 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 rive hundred dollars ($500). _ 0 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.) ❑ 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.) 0 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 f3'Copy is filed with the city. O Certified copy is hereby furnished. 1� CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (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 lhp 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: If, 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. f r �1; Signature of applicant 4 IV; ! (1 ! " 4- irf Date : �r Mailing Address i IF as' City, State, Zip t� V HARD COPY No. 001614 BUILDING: TYPE CONST. V N OCC. GRP. l A.P. Number Legal Description Project Description Plat 4 40 Sq. Ft. 3142 No. Size 5A9 Stories New Add ❑ Alter ❑ No. Dw. Units Repair ❑ Demolition ❑ tstlmateo valuation 197,349.00 PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. AIA 14 Const. f� Mech. et Electrical I 7111t _ r+S Plumbing 1AA ICA S.M.I. 11-11Z Grading Driveway Enc. Infrastructure TOTAL 3,580.17 3,330.1.7 REMARKS th'h1 qW 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:s_ ' ��� Date 7-11—BS Permit Validated by: IF Validation: A223.6 88 33301.7. CK.-.. CONSTRUCTION ESTIMATE NO. ELECTRICAL FFd@IL NO. PLUMBING FEES 1ST FL. SO. FT. ® UNITS COLL. AREA 2ND FL. SO. FT. 5 YARD SPKLR SYSTEM POR. SO. FT. ® MOBILEHOME SVC. BAR SINK GAR. SO. FT. ® POWER OUTLET ROOF DRAINS CAR P. S0. FT. DUCT WORK DRAINAGE PIPING WALL SO. FT. p DRINKING FOUNTAIN SO FT ® HEATING (FINAL) URINAL ESTIMATED CONSTRUCTION VALUATION $ 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(AUTO)(DISH) APPLIANCE DRYER GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED GRADING cu. yd. $ plus x$ LAUNDRY TRAY 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 SO. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 11/4 c SEWAGE DISPOSAL FIREPLACE SO.FT.GAR ® 3/ac HOUSE SEWER SPARK ARRESTOR 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 ,yGROUND PLUM BING$ /q O UNDERGROUND A.C. UNIT COLL. AREA -rl/4LABGRADE 5 ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMS SEWER OR SEPTIC TANK ROUGH WIRING DUCT WORK ROCK STORAGE r FOUND. REINF. a� 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. $ plus x$ _$ LUMBER GR. FINAL INSP. FRAMING /0 FINAL INSP. ROOFING REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATION/SOUND ID �j u FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURES/INITIALS, GARDEN WALL FINAL