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14671 (RR)Building Address '77-595• Calla Owner P.O. BOX 1504 78-495 CALLE TAMPICO ,. LA QUINTA, CALIFORNIA 92253 Malting Address P.O. S x 2078 City Zip Tel. Indio 92201 Contractor P.b. contractors Address P..0 In= 2i95 City Palm Desert & Classif. 477507 Arch., Engr., Designer Address Tel.: 2260 • 346-2.420 City Lic.# 432 Tel. Y No. 14671 ti BUILDING: TYPE CONST. OCC. GRP. A.P. Number s Legal Description Project Description�"��� Sq. Ft. No. No. Dw. Size Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ City 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 ' E I hereby affirm that I am exempt from the Contractor's License Law for the following reason: (Sec. 7031.5,8uskress 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 pemut 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 Divlsfon 3 o! the Business and professions Code, or that. he is exempt therefrom, and the basis for the alleged exemption. Any violation of Section 7031.5 by 'any applicant for a permit subjects the applicant to a civil penahy o! not more than five hundred dollars ($500). , ❑ I, as owner of the property, or my employees with wages as their sole compensation, will j do the work, and the structure is not intended or offered for sale. (Sec. 7044, tiuisness 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-buRder will have the burden of proving that he did not build or knprove 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 j 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.) i❑ 1 am exempt under Sec B. it 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 ❑ Copy is filed with the city, O 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- (x100) valuation or less.) I certify that in the performance of thg 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 Cali omnia Date Owner NOTICE TO APPLICANT: H, after maiming 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 tirk permit shall be deemed revoked. WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. 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. Signature of applicant . Date Mailing Address City, State, Zip stimated Valuation AA. no, f3 PERMIT • AMOUNT Plan Chk. Dep. Plan Chk. Bal. Const. 30.00 Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure TOTAL a 0.00 REMARKS ��l ZONE: BY: Minimum Setback Distances: Front Setback from Center Line Rear Setback from Rear Prop. Line Side Street Setback from Center Line :3 Side Setback from Property Line FINAL DATE INSPECTORS--�'��_`� Issued Date_' i �P�mit by: _1 I-" Validated by: I I 11 Validation: r 1= D V � 1 ��l CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBINU FEES IST FL. SO. FT. ® $ UNITS COLL. AREA SLAB GRADE ROUGH PLUMB. YARD SPKLR SYSTEM 2ND FL. S0. FT. a HEATING (ROUGH) STORAGE TANK FORMS MOBILEHOME SVC. BAR SINK POR. SO. FT. ® DUCT WORK ROCK STORAGE GAR. SO. FT. ® POWER OUTLET ROOF DRAINS METER LOOP HEATING (FINAL) DRAINAGE PIPING CAR P. SO. FT. 0 GAS (FINAL) WALL SO. FT. ® DRINKING FOUNTAIN GROUT WATER HEATER URINAL SO. FT. ® FINAL INSP. ESTIMATED CONSTRUCTION VALUATION $ WATER SYSTEM WATER PIPING NOTE: Not to be used as property tax valuation GRADING cu. yd. $ plus x$ 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 REMARKS: 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 ® 11A c SEWAGE DISPOSAL SO.FT.GAR ® 3/ac HOUSE SEWER MESH 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 APP./EOUIP. 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 f1 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