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05156 (MFD5)T,it4t 4 4 Q" P.O. BOX 1504 Building 78-105 CALLE ESTADO Address 78-173 Crimson Drive LA QUINTA, CALIFORNIA 92253 Owner Address - A "eta ! w Gt.. N a .Y .1► nJQA City `" ' Zip "~ ` ' ' el:� " t3ral�f;c 92580 714-547--8056 Contractor City State Lic. City & Classif. 311251 Lic. # 1177 Arch., Engr., Designer Address I Tel. CityI Zip I State I Lic. # LICENSED CONTRACTORS 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 + _SIGNATURE f DATE OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason: (Sec. 7031.5,11rsiiess and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repay any structure, prior to its issuance also requires the appicant for such permit to fie a signed statement that he is licensed pursuant to the provisions of the Contractors 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 civilpenally 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 orimprovement is sold within one year of completion, the owner -budder will have the burden of proving that he did not build or irpmve for the purpose of sale.) ❑ I, 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 bulls or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) O 1 am exempt under Sec_ R. g 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 copy thereof. (Sec. 3800, Labor Code.) Policy No. Company ❑ Copy is filed with the city. O Certified copy is hereby fumished. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed ff the permit is for one hundred dollars (5100) valuation or less.) I certify that in the performance of thg 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: ff, after making the Certiricate of Exemption you should become subject to the Workers' compensation provisions of the Labor Code, you must forthwith comply with such provisions or On 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, CinT 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 ateMailing Address City, State, Zip No. 05156 BUILDING: TYPE CONST. OCC: GRP. A.P. Number 631-790-009 ,Legal Description Project Description Building 36. Plan 3U. Lot 331 Sq. Ft. 763 Size No. No. Dw. Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation $56=885 PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. 251.81 Const. 304.00 Mech. 314,00 Electrical A Plumbing A3, WI S.M.I. 1.44 Grading Driveway Enc. Infrastructure 1,279.94 w saw -► T i+ w �# A TOTAL 92.015.67 - -r REMARKS ll Av +frit i r{.rarwtr A .. .:k— o m 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 12/78/88 Issued by: Date Permit Validated by: Validation: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL SO. FT. ® $ UNITS SLAB GRADE ��� ROUGH PLUMB. BONDING YARD SPKLR SYSTEM 2ND FL Sp. FT. @ FORMS SEWER OR SEPTIC TANK ROUGH WIRING MOBILEHOME SVC. BAR SINK POR. Sp. FT. ® AS (ROUGH) METER LOOP GAR. SO. FT. ® POWER OUTLET ROOF DRAINS GAS (FINAL) TEMP. POLE DRAINAGE PIPING CAR P. Sp. FT. GROUT WATER HEATER WALL Sp. FT. FINAL INSP. DRINKING FOUNTAIN. SO FT ® WATER SYSTEM URINAL ESTIMATED CONSTRUCTION VALUATION $ =$ WATER PIPING NOTE: Not to be used as property tax valuation FRAMING/ O I FLOOR DRAIN , MECHANICAL FEES WATER SOFTENER VENT SYSTEM FAN EVAP.000L HOOD SIGN WASHER(AUTO)(DISH) 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 SO. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 11/. c SEWAGE DISPOSAL SO.FT.GAR ® V/ic HOUSE SEWER FINISH GRADING 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 i 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. + (Z Z 7 AS (ROUGH) METER LOOP HEATING (FINAL) OTHER APPJEOUIP. REINF. STEEL GAS (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM FINAL INSP.) �d GRADING cu. yd. $ plus x$ =$ LUMBER GR. FRAMING/ O I FINAL INSP. ROOFING REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWAL �, ;Z4 LATHING MESH INSULATIONISOUND_'� FINISH GRADING FINAL INSPECTION*, d� CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURES/INITIALS GARDEN WALL FINAL