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05341 (BLCK)Building Address Owner .53-980. IAFARRO P.O. BOX 1504 78-105 CALLE ESTADO LA QUINTA, CALIFORNIA 92253 MMESTHM AnRTCM CONSMCTION Mailing Address P.O.. BOX 1.375 City Zip Tel. LA QUINTA 92253 564-7411 Contractor , C. RMOLDS CONSTRUCTION Address P.O. BOX A-07 j CityZip Tel.' 1000 PALMS 92276 346-1408 State Lic. City & Classif. 11- 469157 Lic. # i114 n Arch., Engr., Designer Address I Tel. City I Zip I State Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I ain 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. Ae SIGNATURE ,e' r DATE OWNER BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractor's License Law for the following reason: (Sec. 7031.5,8usiness and Professions Code: Any city or county which requires a permit to construct, after, improve, demofslm, or repair any structure, Prior to its issuance also requires the applicant for such permit to Me a signed statement that he is licensed pursuant to Me 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 penally of not more than five hundred dollars ($500). ❑ 1, 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 Contractors 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 -budder will have the burden of proving that he did not build or inprove for the Purpose of safe.) ❑ 1, 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_ R_ & P.C. for this reason Date Owner WORKERS' COMPENSATION DECLARATION I hereby affirm that 1 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. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed If the permit is for one hundred dollars ($100) valuation or less.) I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to,therWorkers' Compensation taws of California. Date Owner t NOTICE TO APPLICANT: If, after making this Certificates of Exemption you should become subject to the Workers' Compensation provisions` of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code.) Lender's Name Lender's Address This is a building permit when property filled out signed and validated, and is subject to expiration if work thereunder is suspended for 180 days. I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives -of this city to enter the above-. mentioned property for inspection purposes. Signature of applicant Date Mailing Address City, State, Zip No. 0534. BUILDING: TYPE CONST. OCC: GRP. A.P. Number ,Legal Description LOT11 WX 251 URIT 23 Project Description 130 LIN. FT OF 3'X$ RETAMUNG WAM Sq. Ft. Size' • No. No. Dw. Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation 1,500 PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. Const. 162.00 Mech. Electrical Plumbing S.M.I. 1.05 Grading Driveway Enc. Infrastructure .�. .... .4.-. mew r.n. ...,_ TOTAL li 1 � . � "-V � ., �w�`.r,.�,.�� •.��`�.• i�r. �°� �,. 3, E y REMARKS 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 218189 Permit Validated by: Validation: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES r 1ST FL. SO. FT. ® $ 2ND FL SO. FT. ® POR. SO. FT. ® GAR. SO, FT. ® CAR P. SO. FT. WALL SO. FT. ® SO, FT ® ESTIMATED CONSTRUCTION VALUATION $ UNITS MOBILEHOME SVC. POWER OUTLET YARD SPKLR SYSTEM ' BAR SINK ROOF DRAINS DRAINAGE PIPING DRINKING FOUNTAIN. URINAL WATER PIPING NOTE: Not to be used as property tax valuation FLOOR DRAIN MECHANICAL FEES HEATING (ROUGH) WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTONDISH) APPLIANCE DRYER DUCT WORK GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED ►� LAUNDRYTRAY AIR HANDLING UNIT CFM HEATING (FINAL) KITCHEN SINK ABSORPTION SYSTEM B.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 BOND BEAM SO. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 1+/. c SEWAGE DISPOSAL LUMBER GR. SO.FT.GAR ® V4c HOUSE SEWER FRAMING FINAL INSP. GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEE MECH.FEE PL.CK.FEE ----[COT. NSFEE 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 ROCKSTORAGE FOUND. REINF. ►� GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APPJEOUIP. 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 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