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05369 (RPL)Building Address P.O. BOX 1504 78-105 CALLE ESTADO LA QUINTA, CALIFORNIA 92253 Mailing Address City Zip Tel. 92253 Contractor CAL ITEST CCNSURuCra0111a Zip & Classif: B! 358739 1 Lic. # 926 Designer Address I Tel. CityI Zip I State Lic. # LICENSED CONTRACTOR'S DECLARATION 1 hereby affirm that am licensed under provisions of -,Chapter 9 (commencing with Section 7000) of Division 3 of the Business andProtessio 'Oode,.and_ my license is In full force and effect. j �: 77, SIGNATIHE .� tr '- __.! ='t.�.S�•-' •�-I DATE OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason: (Sac. 7031.5,8usbass and Rofietssisos Code:- Any dty or county which requires a permit to construct. agar. Improve. derno8sh, - repsh any structure. prior to Its issuance also hir such penriff to So iovhs=a, p t Lav, t�ppter (cosigned mmencing wM ensed �70 0) of Dhdsion 9 of the Business and Professions Code, or that, he is exempt therefrom, and the basis for the alleged exeml on. Any violation of Seaton 7031.5 by any. applicant for a perml subjects the -appBcmh'to 'a dna penalty of not mors than five hundred dollars (S50(1). ❑ 1, as owner of theproperty, or my employees•with wages as their sole compensation, will do the wank, and the structure is mot intended or offered for'saIs. (Sec. 7044, Suisness and PrMeaalorhs Code: The CourhaCtorB License Law does not appy to an owner of property who bogie ar improves rherean and who does such work himself or through his own employees, provided Mat such improvements are not hhtended or offered for sale. H, however, the budding or trgprovmnern is sold wghl one year of cor;eaan. Me owner -budder w/d have the burden of proNrg that he did not build of Improve for the purpose of sate.) O k as owner of the property; am exclusively contracting with licensed contractors to con- struct the projecL (See: 7044, Bushess and Professions Code: The Contractor's License Law does not sp* toan owner of property who builds or bnproves thereon, and who contracts for such projects wfih a contractor(s) geensed pursuant to the Contractor's License Law.) . ❑ 1 am exempt under Sec R. S 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 Workers Compensation Insurance, or a certified copytj�} Sec. 3800, Labor.Code.) Policy No -.Company ,_ J,�"- ❑ Copy is filed with the city. ❑ Certified copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This secsbn need not be completed 8 the permit is for one hundred deters ($100) valuation a kesa.) 1 certify Mat in the performance of"work for which this permit is Issued, I shall not Laws of l'alifern� in arty manner so as to become subject to the Workers' Compensation Data [ltrnnr NOTICE TO APPLfCAhfT: ff, after making this CerbGlkate of Exemptkmn you should become adjeet to the Mbrkers' Compensation Provisions of Me Labor Code, you must lorMwith comply wM such iyw/dons or this Permit shag be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby aNirm that there is a construction lending agency for the performance of the work for which this permit is issued. (See. 3097, CrvgCode.) Lender's Name Larder's AddrPsa This Is abuilding permit when properly filled out, signed and validated, and is subject to expiration if work Uareunder Is suspended for 190 days. 1 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 authorhe representatives of this city to enter the -above.. mentioned property for inspection purposes. Signature, of applicant Date Mailing Address Cly, state, Zip No. BUILDING: TYPE CONST. OCC: GRP.. Number 774-142-A10-01 1. Description Project Description tzfti'tT. ATO qPA 05369 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 .189 Permit Validated by: Validation: Sq. Ft. Size No. Stories No. Dw. Units New ❑ Add ❑ Alter ❑ Repair ❑ -Demolition ❑ Estimated Valuation 10,030 PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. Const:_ Mech. 24-00 Electrical Plumbing q S.M.I. 247 Grading Driveway Enc. Infrastructure TOTAL e "'. . r. REMARKS ' A aW n_. 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 .189 Permit Validated by: Validation: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SQ. FT. ® $ UNITS SLAB GRADE GH PLUMB. BONDING YARD SPKLR SYSTEM 2ND FL. SQ. Ff. 0 FORMS SEWER OR SEPTIC TANK ) UGH WIRING//_,',, MOBILEHOME SVC. BAR SINK POR. SQ, Fr, ® GAS (ROUGH) METER LOOP GAR. SQ. FT. ® POWER OUTLET ROOF DRAINS GAS (FINAL) TEMP. POLE DRAINAGE PIPING CARP SQ Ff ® GROUT WATER HEATER WALL SQ. Fr. ® FINAL INSP. DRINKING FOUNTAIN' BOND BEAM WATER SYSTEM URINAL SQ FT ® =S LUMBER GR. ESTIMATED CONSTRUCTION VALUATION $ FRAMING WATER PIPING NOTE: Not to be used as property tax valuation ��`f;� J FLOOR DRAIN MECHANICAL FEES REMARKS: WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTOXDISH) APPLIANCE DRYER GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED LAUNDRY TRAY AIR HANDLING UNIT CFM 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. SQ. FT. ® c BATH TUB MESH SO. FT. ® c WATER HEATER MAX HEATER OUTPUT, B.T.U. SQ. FT. RESID ® 1 V. c SEWAGE DISPOSAL FINISH GRADING SQ.FT.GAR @ 3Ac HOUSE SEWER GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEE MECH.FEE PLCK.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 GH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMS SEWER OR SEPTIC TANK ) UGH 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 GRADING cu. yd. i plus xi =S LUMBER GR. FINAL INSP. FRAMING FINAL INSP. ROOFING/ ��`f;� J —A. / /—A 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