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04108 (ADD)4 041013 P.O. BOX 1504 Building78„„ 118 Calla Norte LA QUINTAC Address CALIFORNIA 92253 Owner Mailing Bill iatcbin BUILDING: TYPE CONST. OCC. GRP. Address Sams A.P. Number 769-022--040 City ZipTel. 92253 56 4-�44Q5. Legal Description Contractor Project Description Room addition T. A. Kennedy Construction, - Address 77-350 Arroba City Zip Tel. 1 C�u3u�� 92253 564-4660 State Lic. City & Classif. 442118 Lic. # Sq. Ft. 39 No. No. Dw. Arcli:, Engr., Size Stories Units Designer New ❑ Add ❑ Alter O Repair ❑ Demolition ❑ Address Tel. City Zip State Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of Chapter 91commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. SIGNATURE - '+'` 'r J DATE OWNER -BUILDER DECLARATION Estimated Valuation 2 �� I hereby:affirm'that'I am exempt from the Contractor's License Law for the following a reason: (Sec. 7031;: 5; Business and Professions Code: Any city or county which requires a permit to construct; atter, 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 provisionsof 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 Plan Chk. Dep. subjects the applicant to a civil penalty of not more than five hundred dollars ($500). O I, as owner of the properly, or my employees with wages as their sole compensation, will Plan Chk. Bal.' r' do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and Const. 'fid Liu 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 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.I. M such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) Grading O 1 am exempt under Sec. B. & P.C. for this reason 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 O Copy is filed with the city. O Certified copy is hereby furnished. TOTAL CERTIFICATE OF EXEMPTION FROM REMARKS 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 thg work for which this permit is issued, I shall not Atic jL [ . i c: _ r.f: , employ any person in any manner so as to become subject to the Workers' Compensation Laws oECalifornia. t A , �' Date 11 l Owner 11:1, J" r' , NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become ZONE: BY: subject to the Workers' Compensation provisionslof the LaboriCode, 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 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.) Side Setback from Property Line Lender's Name Lender's Address FINAL DATE INSPEC OR This is a building permit when properly filled out, signed and validated, and is subject to I SPEC R expiration If work thereunder is suspended for 180 days. �r 1 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, GOLDENROD - ASSESSOR'S OFFICE, HARD COPY - FILE CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING SEES IST FL 50 FT (p S UNITS SLAB GRADE 2ND FL SO FT. a BONDING YARD SPKLR SYSTEM POR SO FTof MOBILEHOME SVC. BAR SINK GARSO. FT. iK POWER OUTLET ROOF DRAINS FOUND. REINF. GAS (ROUGH) DRAINAGE PIPING CAR P. SO FT. ((j OTHER APP.IEOUIP. REINF. STEEL WALL SO. FT. (d TEMP. POLE DRINKING FOUNTAIN SO FT td GROUT URINAL ESTIMATED CONSTRUCTION VALUATION $ FINAL INSP. WATER PIPING NOTE: Not to be used as property tax valuation WATER SYSTEM FLOOR DRAIN MECHANICAL FEES =E WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASH ER(AUTONDISH) APPLIANCE DRYER GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED LAUNDRYTRAY 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. SO. FT. ® c BATH TUB SPARK ARRESTOR - SO. FT. g c WATER HEATER MAX. HEATER OUTPUT. B.T.U. SO. FT. RESID 11/4 c SEWAGE DISPOSAL LATHING SO.FT.GAR (g 3/4c 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 ROCK STORAGE 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. y plus x$ =E 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 DESERT SANDS•UNIFIED SCHOOL DISTRICT ' THMED CU54ENT C AN040rig Highway 111 4. r• AT CID Indio,iCA 92201 'Y CERTIFICATE OF.SCHOOL FACILITY FEE WAIVER T0: C:L��G ;. DATE': 7 Thi s i s' to certify that developer of 3 w 'ch is located at-, - within this school district, is not required to pay school facility f es pursuant to the'authority generated,by Government Code Section-53680. ` Building permits for the project indicated ab' 'may now be'issued by your j u r i sd;ct o- IF VALUATION. IN—Dr TED ON BUILDING -PERMIT. EXCEEDS''$20,0 0, 'r r THIS WAIVER IIS VOID 'AND A, SCHOOL •FA TIES_,, EE:4MUS–T B'E-PAID�PR.I.OR..TO, ISSUANCE,,OF BUILDING",PERMIT. , R fo DESERT SANDS UNIFIED SCHOOL, DISTRICT hite-Building Department YY ow-Facilities Planning Pink-Developer (10)-38 _J) • 1'h. master bedroom ' O Ql-LO- bedroom 2 ®- IT i—" nook 4-n kitchen p J living room -� Hill dining room l , e � 1FI Pi�� A �HITII -, ,- entry '---- • W wU�.. b, F Ell W/ 30 4, ?Ac� ZOS16A qLofv- L 0 s —! bedroom 3 MIN IT 61111 10 MM d1 ` L4 q V�L garage cart �� t• A. -n-zS Cic,� Zl 18 Coe,) 5(Vq W"f(¢0 Plan C Carmel Valley Three bedrooms,three baths 2640 sq ft. (estimated) Unit dtmenetons. Oaths and walkways may vary from else to site due to location 10187