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003755 (RER)C44a P.O. BOX 1504 No. 003755 Buildingr 78-105 CALLE ESTADO Address 78'-136 Cai110 g1Otb-- LA QUINTA, CALIFORNIA 92253.. _ Owner v. .. Jake Thomas BUILDING: TYPE CONST. OCC: GRP. Mailing Address A.P. Number 769-022-034 City Zip Tel. ,La Quinta 92253_ Y Legal Description fiIPK room Project Description Contractor T... A. Keihn6d�, C`4iI3;f tkucti�31 . Address .. w effect. 1. 77»-350 Arro-ba City Validated by: OWNER -BUILDER DECLARATION Tip.'Tel. %a Quinta. 92253 ,564-:4660 reason: (Sec. 7031.5,Business and Professions Code: Any city or county, which requires a-. Stat,` Lic. City •.• & Classif. • 442118 Lic. # Sq. Ft. 9$ No. No. Dw. " Size " - Stories Units Arch..; Engr., . .. _.. New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ ' DeAner Address Tel. Const. 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, 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 .O 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 the -Workers' Compensation ' Laws of California. Date Owner " NOTICE TO APPLICANT., If, after making 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 this permit shall be deemed' revoked. CONSTRUCTION LENDING AGENCY 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.) - Lender's Name Lender's Address 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 AMOUNT $36.'2 56.50 14.€0 Infrastructure TOTAL 15 -7 ,-Z✓ _ REMARKS �"£� � "'�'rr:>iE�, i `i'i}"� FSi,:• f.. ._ `i 4►`7.. l.' : � - ZONE: BY: Minimum Setback Distances: City Zip State . . . - Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I 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. 1. Issued by: _SIGNATURE DATE Validated by: OWNER -BUILDER DECLARATION Estimated ValUatlOn I hereby affirm that I am exempt from the Contractor's License Law for the following reason: (Sec. 7031.5,Business and Professions Code: Any city or county, which requires a-. ' permit to construct, alter, 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 the provisions of the Contractor's License Law,.Chapler 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 Any Section 7031:5 'any for Plan Chk. Dep: alleged exemption. violation of by applicant a permit subjects the applicant'to a civil penalty of not more than five hundred dollars ($500). - - Plan Chk, 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. 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.. 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 I, 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.1. such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) -• Grading ❑.I am exempt under Sec. B. & P.C. for this reason Driveway Enc. 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 .O 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 the -Workers' Compensation ' Laws of California. Date Owner " NOTICE TO APPLICANT., If, after making 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 this permit shall be deemed' revoked. CONSTRUCTION LENDING AGENCY 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.) - Lender's Name Lender's Address 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 AMOUNT $36.'2 56.50 14.€0 Infrastructure TOTAL 15 -7 ,-Z✓ _ REMARKS �"£� � "'�'rr:>iE�, i `i'i}"� FSi,:• f.. ._ `i 4►`7.. l.' : � - 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: Datel/28188 Permit Validated by: Validation: HARD COPY T CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES IST FL. SO. FT. ® $ 2ND FL. SO. FT. ® POR. SQ. FT, ® GAR. SQ, 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 �11—,SLAB GRADEY— l S FLOOR DRAIN MECHANICAL FEES BONDING WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER ROUGH WIRING GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED ROCK STORAGE LAUNDRY TRAY AIR HANDLING UNIT CFM 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. SQ. FT. ®c BATH TUB SO. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SQ. FT. RESID ® 11/4 c SEWAGE DISPOSAL WATER SYSTEM SO.FT.GAR ® 3/ec HOUSE SEWER $ GRADING cu. yd. plus x$ 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 ��1— GROUND PLUMBING UNDERGROUND A.C. UNIT COLL. AREA �11—,SLAB GRADEY— l S ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK ✓adeORMS q — / 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. // `lPOOFING ��'- --VENTILATION O / T� / C //` C �/�lG REMARKS: FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH G�INSULATION/SOUND r jy FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL Cl I Un D JI V MM I YnCA INI 1 IHLJ_ GARDEN WALL FINAL DESERT SANDS UNIFIED SCHOOL DISTRICT w, 82� 8�9 Hi g.. 111 ®TI�i�:.THIS DOCUMENT CiAld 11 ndMio„:CAA ;92201 BE DUPLICATEDe CERTIFICATE OF SQKO.IL FACILITY FEE WAIVER TO: DATE: This is to cer i fy th , , developer of ch -is thin located at � , within . this school district, -is not req ired�,t0 ay sc ool facility tee's pursuant to the authority generated by Government Code Section 53080. Building permits for the project indicate above may now be issued by your jurisdiction. 'F_� A . Department Yellow -Facilities Planning Pink -Developer (10)-38