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09374 (PAT)P.O. BOX 1504 No. 0,9374 Building+ 78-105 CALL ESTADO .. LA QUINTA, CALIFORNIA 922536 ' Address J� +�� R�7+1�3'.'� j��L . Owner r( R 1 f' _. BUILDING: TYPE CONST. OCC: GRP. Mailing Address !:r II1l�y A.P. Number City Zip Tel. 3xa Onintak 92253 564-7610 Legal Description Contractor . Project Description W n 0 r Address lana. wand. tints#-$ra e0 sc` v►/ foot ngg; ;e— City . .v;g S:. '1 9 ..�•a w.3 Zip Tel. _-----7--- _ __ — State Lic. City & Classif. Lic. # Sq. Ft. No. No. Dw. Size 5 , Stories Units Arch.; Engr., Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition Address Tel. City Zip State Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 70 OO) of Division 3 of the Business and Professions Code, and my license is in full force and effect. SIGNATURE DATE OWNER -BUILDER DECLARATION Estimated Valuation I hereby affirm that I am exempt from the Contractors License Law for the following 26 671110,00 • reason: (Sec. 7031.5,Business and Professions Code: Any city or .county which requires a permit toalter, improve, demolish, or repair any structure, prior to its issuance also thconstruct, requires e applicant for such.permlt 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) or ' 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 Plan Chk. Dep. subjects the applicant to a civil penalty of not more than five hundred dollars (3500). ' Plan Ch k.. Bal. ��]] 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 • - Const. Professions Code: The Contractor's License Law does not apply to an. owner of property whop An '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. or improvement is sold within one year. of completion, the owner -builder will have the burden Electrical 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. $ , such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) - Grading -, -" 'C1 Lam exempt under Sec. B.'& P.C.for this reason ;t' Driveway Enc. Date OwneTl L 0 Q _. Infrastructure WORKERS' COMPENSATION DECLARATION 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. TOTAL 19111 4 CERTIFICATE OF EXEMPTION FROM REMARKS WORKERS'COMPENSATIONINSURANCE (This section need not be completed i1 the permit is for one hundred dollars ($100) valuation ¢` ' s''��• -'� ►C' or less.) I certify that in the performance of tha work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Wo kers' Compensation Laws of California. f } e DateOwner J ` �d� t�6 3^ A% NOTICE TO APPLICANT: ��l,,zz`a��`fter--making this certificate of Exempton�hrould become subject to the Workers' .'Cobtpensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING.AGENCY Ihereby 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 ame Lender's Address This is a building permit when properly filled out, signed and validated, and is subject to expiration it work thereunder is suspended for 180 days. I certify that I have read this application and state that the above information is correct. 1 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 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 IST FL. SQ. FT. ® $ 2ND FL. SQ. FT. ® POR. SQ. FT. ® GAR. SQ. FT. ® CAR P. SO. FT. ® WALL SQ. FT. ® SQ. FT. ® ESTIMATED CONSTRUCTION VALUATION $ UNITS MOBILEHOME SVC. POWER OUTLET YARD SPKLR SYSTEM BAR SINK ROOF DRAINS j DRAINAGE PIPING DRINKING FOUNTAIN. URINAL WATER PIPING NOTE: Not to be used as property tax valuation ROUGH PLUMB. FLOOR DRAIN MECHANICAL FEES HEATING (ROUGH) WATER SOFTENER VENT SYSTEM FAN EVAP.000L HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER DUCT WORK GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED GAS (ROUGH) LAUNDRY TRAY . AIR HANDLING UNIT CFM HEATING (FINAL) 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 BOND BEAM SQ. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SQ. FT. RESID ® 11/4 c SEWAGE DISPOSAL LUMBER GR. SO.FT.GAR ® 3/ac HOUSE SEWER FINAL' INSP. ROOFING 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 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 W -'2t /Ot ((l �v. ((l FINAL' INSP. ROOFING ♦� ?7/O/ J j / REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATIONISOUND FINISH GRADING FINAL INSPECTION 2` q( CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL '