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04932 (SFD)414 P.O. BOX 1504 N o , 04932 Building 78-105 CALLE ESTADO Address 49-125 $erenata. Caurt .LAQ,UINTA,CALIFORNIA 92253 Owner Address, 4Z-Vaz « . City Zip Tel. Cathedral elty 92234 1 773-9024 Contractor Address City State Lic. City & Classif. .337077 Lic. # 1219 Arch., Engr., Designer Address Tel. Zip (State Lic. # LICENSED CONTRACTOR'S DECLARATION 1 hereby affimr!A!at I am licensed under provisions of Chapter 9 (commencing with Section e7000) of b�� 3 o Division of Busirl license Professions Code, and my licenis in full orrce and r SIGNATURE DATE OWNER -BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractor's License Law for the following reason (Sec. 7031.5,13usiness and Professions Code: Any city or county which requires a permit to construct, after, lrtprove, demolish, or repair any'struclure, prfor to its issuance also requires the applicant for such permit to file a signed statement that he is licensed pursuant to 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 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 c" penalty of not more than rive hundred dollars ($500). ❑ 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 Professions Code., The Contractor's License Law does not apply to an owner of property who binds or improves thereon and who does such work himself or through his own employees, provided that such improvements are not intended or offered for safe. If, however, the building or inprovement 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.) ❑ 1, 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 inproves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) ❑ 1 am exempt under Sec. B. & P.C. for this reason 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 ❑ Copy is filed with the city. ❑ Certified copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (ibis section need not be completed it the permit is for one hundred dollars ($100) valuation or less.) 1 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 N077CE TO APPLICANT.ff. 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 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 abuilding permit when properly filled out, signed and validated, and is subject to expiration it work thereunder is suspended for 180 days. certify that I have read this application and state that the above information is correct. 1 agree to comply with all city and countyordinancesand 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 BUILDING: TYPE CONST: OCC: GRP. A.P. Number Part La QuInta. Legal Description Project Description ?Tait 1804 - Lot Sq. F,t. 1804 No. No. Dw. Size Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation $93,604 -'" PERMIT -AMOUNT Plan Chk. Dep. Plan Chk. Bal. 5 347.24 Const. 415.00 Mech. 13.0-0 Electrical % 2 tib Plumbing 93b .00 S.M.I. 6.55 Grading Driveway Enc. Infrastructure 2,106.09 TOTAL $3,076.92 REMARKS y A YY Yi.i! r .y r v t a c*,. a .+• a a+ � ..� 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 12/19/88 Issued by: Date Permit Validated by: Validation: I ' CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES PLUMBING FEES 1ST FL. SQ. FT. ® $ UNITS r HEATING (ROUGH) STORAGE TANK YARD SPKLR SYSTEM 2ND FL. SQ. FT. DUCT WORK ROCK STORAGE FOUND. REINF. A�� MOBILEHOME SVC. BAR SINK POR SQ FT ® REINF. STEEL GAS (FINAL) TEMP. POLE POWER OUTLET ROOF DRAINS GAR. SQ. FT. ® FINAL INSP. I BOND BEAM WATER SYSTEM DRAINAGE PIPING CAR P. SQ. FT. ® LUMBER GR. / FINAL INSP. ��iTi( /J j FRAMING TT TTT FINAL INSP. DRINKING FOUNTAIN. WALL SQ. FT. REMARKS. URINAL SO FT ® ESTIMATED CONSTRUCTION VALUATION $ WATER PIPING NOTE: Not to be used as property tax valuation FLOOR DRAIN MECHANICAL FEES WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED LAUNDRY TRAY AIR HANDLING UNIT CFM MESH 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 CERT. OCC. SQ. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SQ. FT. RESID ® 11/4 c SEWAGE DISPOSAL INSPECTOR'S SIGNATURES'INITIALS 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 D PLUMBING n— 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. A�� GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APPJEOUIP. 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. ��iTi( /J j FRAMING TT TTT FINAL INSP. ROOFING t1 (� v� 0 L f� _ fJ � REMARKS. VENTILATION FIRE ZONE ROOFING: FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATIONISOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURES'INITIALS GARDEN WALL FINAL