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002923 (BLCK)Contractor .. Address State Lic. & Classif., . -'Arch., Engr., Designer Address P.O. BOX 1504 No: 002923 78-105 CALLE ESTADO LA QUINTA, CALIFORNIA 92253 l BUILDING: TYPE CONST. OCC: GRP. A.P. Number Tel. Legal Description Project Description L)lly Lic. # Sq. Ft. $x � fa. No. No. Dw. Size - Stories • Units Tel. New= Add ❑ Alter ❑ Repair ❑ Demolition ❑ City Zip State ... . . Lic. # .. . LICENSED CONTRACTOR'S DECLARATION T I hereby affirm that I am licensed under provisions of Chapter 9'(conmencing with Section 7000) of Division 3 of the Business and Professions Code, and my licanse 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 followingu;��3� reason' (Sec 7031 5 Bsiness and Professions Code' An cit 'or count whi h o s y y .y - c requires a permit to construct, alter, improve, demolish, or repair any 'structure, poor to its* issuance also requires the applicant for such permit to file a signed statementthah'he-is licensed pursuant to .,.r PERMIT Building Address 51-422 C61.10T:U0 Owner Plan Chk.Dep.; . '• subjects the applicant to a civil penalty of not more than five hundred dollars jS500). . 0 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 Code: The Contractor's License Law does not apply to an owner of property who Plan Ch k. Bal Mailing ' Address City Plumbing Zip . Contractor .. Address State Lic. & Classif., . -'Arch., Engr., Designer Address P.O. BOX 1504 No: 002923 78-105 CALLE ESTADO LA QUINTA, CALIFORNIA 92253 l BUILDING: TYPE CONST. OCC: GRP. A.P. Number Tel. Legal Description Project Description L)lly Lic. # Sq. Ft. $x � fa. No. No. Dw. Size - Stories • Units Tel. New= Add ❑ Alter ❑ Repair ❑ Demolition ❑ City Zip State ... . . Lic. # .. . LICENSED CONTRACTOR'S DECLARATION T I hereby affirm that I am licensed under provisions of Chapter 9'(conmencing with Section 7000) of Division 3 of the Business and Professions Code, and my licanse 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 followingu;��3� reason' (Sec 7031 5 Bsiness and Professions Code' An cit 'or count whi h o s y y .y - c requires a permit to construct, alter, improve, demolish, or repair any 'structure, poor to its* issuance also requires the applicant for such permit to file a signed statementthah'he-is licensed pursuant to .,.r PERMIT the provisions of 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 dlerefrom, 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 jS500). . 0 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 Code: The Contractor's License Law does not apply to an owner of property who Plan Ch k. Bal Const. �Mech. ' 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. .y,: however; the building , Electrical or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he did not build or improve for the purpose of sale.) Plumbing O 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 builds or improves.thereoa; and who contracts for S.M.I. • such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) - . ❑ I am exempt under Sec. B. & P.C. for this reason Grading Driveway Enc.,,,,, ... , . Z ' 1 7 Y �. "., i'..c' . "- Date 0wner -� L-� t - Infrastructure ` f I,: NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become ZONE: 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.) Minimum Setback Distances: Policy No. ' Company ❑ Copy is filed with the city. ❑ Certified copy is hereby furnished. TOTAL Rear Setback from Rear Prop. -Line AMOUNT 20.00 20w0u . CERTIFICATE OF EXEMPTION FROM REMARKS WORKERS' COMPENSATION INSURANCE' (This section need not be completed if the permit is for one hundre4 dollars ($100) valuation or less.)- - I certify that in the performance of thg work for which this per -hit is issued, 1 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 ZONE: BY: • subject to the Workers' Compensation provisions 'of the' Labor Gude, you must forthwith comply with such provisions or this permit shall be deemed revoked. Minimum Setback Distances: 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 INSPECTOR This is a building permit when properly filled out, signed and vaidated, and is subject to expiration if work thereunder is suspended for 180 days. I certify that I have this �� read application and state that the above- information is correct. 'aws Issued by: 4 �� Date 4 Permit agree to comply with all city and county ordinances and state relating to building construction,and hereby authorize representatives -of. this cit- to enter 'the above- mentioned property for inspection purposes. r � Validated by: Signature of applicant 7 r +vim •-- �" `- �4 "'' T Date -i ; _ F7 Mailing Address if r Validation: City, State, Zip A 7 3 1 4 2 12 10.60 Ch HARD COPY CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES IST FL. SQ. FT. p $ 2ND FL. SQ. FT. ® POR. SQ. FT. ® GAR. SQ. FT. ® CAR P. SQ. FT. ®. WALL SQ. FT. ® SQ. 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 BONDING FLOOR DRAIN MECHANICAL FEES FORMS WATER SOFTENER VENT SYSTEM FAN EVAP.000L HOOD SIGN WASHER(AUTO)(DISH) . APPLIANCE DRYER GAS ,'ROUGH) GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED OTHER APPJEQUIP. LAUNDRY TRAY AIR HANDLING UNIT CFM TEMP. POLE 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 SQ. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SQ. FT. RESID ® 11/4 c SEWAGE DISPOSAL ®�� . ,vim• SQ.FT.GAR ® 3/ac 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 & 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 f0`/.IFOUND.'REIN Fa / - c 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. $ plus x$ =$ LUMBER GR. FINAL INSP. FRAMING FINAL INSP. ROOFING ®�� . ,vim• i f REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATIONISOUND FINISH GRADING FINAL INSPECTION CERT: OCG -FENCE FINAL. nnarm� i vas a awash i vnwnm I iNw GARDEN WALL FINAL