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03985 (GRES)4 P.O. BOX 1504 Building 5-1-523`LA QUINTA CALFORNIA 92253 Address �� Juarez_ Owner _ lR^C2Y' Mailing BUILDING: TYPE CONST. OCC. GRP. Address "` A.P. Number 773t,442-016 017 City Zip Tel. „ Legal Description - Contractor Project Description Garage C}max'/Hui lder Address - City Zip Tel. State Lic. City & Classif. 497504 Lic. # � Sq. Ft. �� No. No. Dw. Arch., Engr., Size Stories Units Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ 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) t. of Division 3 of thep �Bus,iness and,Professlons Code, and my license is in full force and effec��,,,v,...•"° - +s.+•�'""" . SIGNATURE M DATE OWNER -BUILDER DECLARATION Estimated Valuation I hereby affirm that I am exempt from the contractor's License Law for the following reason: (Sec. 7031.5,Susiness 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 permit to file a signed statement that he is licensed pursuant to PERMIT AMOUNT the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, or thathe is exempt therefrom, and the basis for the alleged exemption. Any violation of Section 7031.5 by 'any applicant for a permft Plan Chk. Dep. subjects the applicant to a civil penalty of not more than five hundred dollars ($500). " O I, as owner of the property, or my employees with wages as their sole compensation, will Plan Chk. Bal. do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and Const. # 4* +ski 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, Mech. provided that such improvements are not intended or offered for sale. If, however, the building .of improvement is sold within one year of completion, the owner -builder will have the burden Electrical d, UV of proving that he did not build or improve for the purpose of sale.) O 1, 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 not apply to an owner of property•who builds or improves thereon, and who contracts for S.M.I. • OV such projects with a contractor(s) licensedpursuant to the Contractor's License Law.) ❑ 1 am exempt under Sec. B. & P C. for this reason Grading Driveway Enc. Date Owner ✓ Infrastructure 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. ❑ Certified copy is hereby furnished. 1\ N TOTAL CERTIFICATE OF EXEMPTION FROM REMARKS WORKERS'COMPENSATIONINSURANCE (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 th8 work for which this permit is issued, I shall not Tt'�r:ttcr,t4'rx {yrs—,1 ^f3f. , j 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 ZONE: BY: subject to the Workers' Compensation provisions of the Labor Code, you must forthwith Minimum Setback Distances: comply with such provisions or this permit shall be deemed revoked. Front Setback from Center Line Rear Setback from Rear Prop. Line CONSTRUCTION LENDING AGENCY Side Street Setback from Center Line whic I hereby affirm that there is a construction lending agency for the pertormance of the work for h this permit is issued. (Sec. 3097, Civil Code.) Side Setback from Property Line Lender's Name t Lender's Address INSPECTOR This Is a building permit when properly filled out, signed and validated, and is subject to FINAL DATE INSPSPEE c1O expiration if work thereunder is suspended for 180 days. -•1 I certify 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 -WHITE - FINANCE, PINK - APPLICANT, GREEN -'BUILDING, GOL0ENO91) • A55966OR'S OFFICE, HARD COPY - FILE CONSTRUCTION ESTIMATL NO. ELECTRICAL FEES NO. PLUMBING FEES ISI FL SO Fl rp S UNITS COLL. AREA SLAB GRADE ROUGH PLUMB YARD SPKLR SYSTEM 2ND FL SO FT. M HEATING (ROUGH) STORAGE TANK FORMS MOBILEHOME SVC. BAR SINK POR SO FT, * DUCT WORK ROCKSTORAGE GAR SO. FT. 0 POWER OUTLET ROOF DRAINS HEATING (FINAL) DRAINAGE PIPING CARP. SO FT. 6 GAS (FINAL) TEMP. POLE WALL SO FT. (d DRINKING FOUNTAIN GROUT WATER HEATER URINAL SO FT 0 FINAL INSP. ESTIMATED CONSTRUCTION VALUATION S WATER SYSTEM WATER PIPING NOTE, Not to be used as property tax valuation GRADING cu. yd. $ plus x5 FLOOR DRAIN MECHANICAL FEES WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTONDISH) APPLIANCE DRYER S 7l 'a✓ GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED LAUNDRYTRAY AIR HANDLING UNIT CFM VENTILATION lKITCHEN SINK ABSORPTION SYSTEM E.T.U. TEMP USE PERMIT SVC WATER CLOSET COMPRESSOR HP POLE, TEMIPERM LAVATORY HEATING SYSTEM FORCED GRAVITY AMPERES SERV ENT SHOWER BOILER B.T.U. SO. FT. @ c BATH TUB GAR. FIREWALL SO. FT. a c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO, FT. RESID g 1+i. c SEWAGE DISPOSAL SO.FT.GAR 3i4c HOUSE SEWER 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 8 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 ROCKSTORAGE FOUND. REINF. 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 x5 =S LUMBER GR. FINAL INSP FRAMING FINAL INSP. ROOFING 6 2 S 7l 'a✓ REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATIONISOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURES/INITIALS GARDEN WALL FINAL