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08725 (RPL)Building P.O. BOX 1504 78-105 CALLE ESTADO �/ �j u$ Z* Address 76-990 AVENIDA: FERNANDO LA QUINTA, CALIFORNIA 92253 Owner Poot H L. BA8RB8 BUILDING: TYPE CONST. SPA OCC. GRP.- Mailing Address A.P. Number CityZip Tel. tiII _ C S Legal Description Contractor Project Description PQ©LISPA/DECKTRO .. RVR Address ..805 A Srr sr A City _ >E7 R Ji17-Tela [' Q Z Ort State Lic. City & Classif. A574127 Lic. # 1044 Sq. Ft. No. No. Dw. Size Stories Units Arch., Engr., ' Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Address Tel. City Zip State Lic. # �1LICENSEDI6ONTRACTOR'S DECLARATION I'hereby affirm that Dram licensed oder provisions of Chapter,9 (commencing with Section 7 0) of Divisio(p. 3/o'f{•the Busines anrr rofessibris Code, and my license is in full force and (felt. • - �t Iii I'l �� .�� - I SIGNATURE DATE 7 I hereby affirm that I am exempt from tjhe Contractors License Law for the following reason: (Sec. 7031.5,Business and Professibntle: 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 lo.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). ❑ 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.) ❑ 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 O Copy is filed with the city. 0 Certified copy is hereby furnished. 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 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., U, 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. fSignature of applicant Date Mailing Address City, State, Zip 3timated Valuation PERMIT L AMOUNT Plan Chk: Dep. z' Plan Chk. Bal. ,p180.00 Cof1St.li24.00 Mech. � 43.00 Electrical 22 n(I Plumbing q S.M.I. Grading Driveway Enc. Infrastructure TOTAL REMARKS ` J 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: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SO. FT. ® $ UNITS A.C. UNIT 2ND FL. S0. FT. SLAB GRADE YARD SPKLR SYSTEM POR. SO. FT. ® MOBILEHOME SVC. BAR SINK GAR. SO. FT. ® POWER OUTLET ROOF DRAINS DRAINAGE PIPING CAR P. I SO. FT. ROUGH WIRING DUCT WORK WALL SO. FT. FOUND. REIN DRINKING FOUNTAIN SO. FT. ® GAS (ROUGH)G 012— Q URINAL ESTIMATED CONSTRUCTION VALUATION $ OTHER APPJEQUIP. 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 SERVICE GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED BOND BEAM LAUNDRY TRAY AIR HANDLING UNIT CFM WATER SYSTEM 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 FIRE ZONE ROOFING SO.FT.GAR ® V4c HOUSE SEWER FIREPLACE GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEE MECH.FEE PL.CK.FEE CONST. FEE IELECT. FEE SMI FEE PLUMB. FEE STRUCTURE / PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR SETBACK 0 GROUND PLUMBING O(2 LPUNDERGROUND A.C. UNIT COLL. AREA SLAB GRADE ROUGH PLUMB. BONDING I 2`�-c� HEATING (ROUGH) STORAGE TANK FORMS SEWER OR SEPTIC TANK ROUGH WIRING DUCT WORK ROCKSTORAGE FOUND. REIN GAS (ROUGH)G 012— Q 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 ^, /�,© � I'� REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATION/SOUND FINISH GRADING FINAL INSPECTION < Qf CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURES/INITIALS GARDEN WALL FINAL