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05456 (SFD)4 P.O. BOX 1504 N o . Building M 78-105 CALLE ESTADO Address 77 -WO Fern do LA QUINTA, CALIFORNIA 92253 Owner Address p.(). 130g TSO City Zip Tel. la Quiuta 92253 6191564-1315 Contractor BariilO COnat. Address .P.O. Box 1540 La Wuta 92253 State Lic. City & Classif. 37-8318 Lic. # 189 Arch., Engr., + Designer Address Tel. CityI Zip ( State Lic. # LIQ CONTRACTOR'S DECLAMATION I hereby affirm that 1 am 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,�- SIGNATURE DATE OWNER BUILDER DECLARATION reason(Sec. hereby affirm 7031-5,��ness arid I am �Professions Code: from the yrs License Law for the following Any city or county which requires a permit to canstnrct, alter, improve, deroish, or repair any structure, pnor to its issuance also requiresthe appiicad for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractors License Law, Chapter 9 (commencing with Section 7000) or Division 3 of the Business and PrWessions 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 sub)eets the appicant to a civilpenalty 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, Suisness and Prolessions Code: The Cardrmfors License Law does not apply to an owner of property who twills or improves thereon and who does such work himself or through his own employees, provided that such Improvements aro not rderded or offered for sale. ff, however, the building or Improvement is sold -NA, one year of completion, the owner-buflder will have the burden of proving that he did not build or inprove for the purpose of sale.) , ©'1, as owner of the property, am exclusively contracting with licensed contractors to con- struct the project (Sec. 7044, mss and Professions Code: The Contractor's License Law does not apply to an owner of property who bolds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) O 1 am exempt under Soo R & P.C- for this reason Date":y i r .� Owner WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self -insure, or a certificate of Workers Compensation Insurance, ora certified copy thereof. (Sec. 3800, Labor Code.) Policy No Company O Copy is filed with the city. ❑ Certified copy is hereby furnished. CWI TIFICATE OF EXEMPTION FROM WORKERS COMPENSATION INSURANCE (This section need not be comoWed if the peels for one hundred dollars ($100) valuation or less.) 1 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 ✓f _ ... _._ NOTICE TO APPLICANT: B, after m9ft this Certificate of Exemption you should become subject to the Workers' Conpesako provsfans of the Labor Code, you must forthwith comply with such provisions or this peed shalt be deemed revoked. CONSTRUCTION LENDING AGENCY i 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.) Lenders Name Lenders Address This is abuilding permit when property 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. Signature of applicant Date Mailing Address City, -State, Zip 05456 BUILDING: TYPE CONST. OCC: GRP. A.P. Number 8=ta It 119 Legal Description P• .lar i3Ot 5 Project Description Sq. Ft. Size 3110 No. Stories No. Dw. Units NewKD Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation $216,509.00 PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. $60.503 Const. 1 .00 t Mech. tS.5C3 Electrical . 5.3 5 Plumbing 200.00 S.M.I. 15.19 Grading Driveway Enc. Infrastructure 4,871.46 TOTAL REMARKS yq 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 r FINAL DATE INSPECTOR 3/8/89 Issued by: Date Permit Validated by: Validation: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES. NO. PLUMBING FEES 1ST FL SO. FT. ® $ UNITS COLL. AREA SLAB GRADE YARD SPKLR SYSTEM 2ND FL SO. FT. @ HEATING (ROUGH) STORAGE TANK FORMS MOBILEHOME SVC. BAR SINK POR. SO. FT. ® DUCT WORK ROCK STORAGE GAR. Sp. FT, ® POWER OUTLET ROOF DRAINS METER LOOP HEATING (FINAL) DRAINAGE PIPING CAR P. SQ. FT. GAS (FINAL) TEMP. POLE WALL Sp. FT. DRINKING FOUNTAIN. SQ FT ® WATER HEATER URINAL ESTIMATED CONSTRUCTION VALUATION $ WATER PIPING NOTE Not to be used as property tax valuation WATER SYSTEM FINAL INSP. 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 VENTILATION 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. SQ. FT. ® c BATH TUB SQ. FT. ® c WATER HEATER MAX HEATER OUTPUT, B.T.U. SQ. FT. RESID ® 1 Va c SEWAGE DISPOSAL SO.FT.GAR ® 3/ac HOUSE SEWER INSULATIONISOUND GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEE MECH.FEE PL.CK.FEE CONST. FEE JELECT.FEE SMI FEE PLUMB. FEE STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR SETBACK ROUND PLUMBING I. 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. RFINF. GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APPJEQUIP. p REINF. STFEL all GAS (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM FINAL INSP. J FINAL INSP._cu. dd / !PIV GRADING yd. $ plus x$ _$ LUMBER GR. FRAMING ROOFING r /y � I l /Qj� ® `� .0 REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL SIN � G MESH INSULATIONISOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURES/INITIALS GARDEN WALL FINAL I