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05074 (SATT)44 P.O. BOX 1504 No. Building 78-105 CALLE ESTADO Address 56-400 Tanglewood .LA QUINTA, CALIFORNIA 92253 Owner Mailing Address A?C ftp City Zip Tel. R-4. nA a Address 05074 BUILDING: TYPE CONST. OCC: GRP. t A.P. Number pf_A &1^m R% ai:in 31 A Legal Description Project Description c» GF rats City Zip Tel." State Lic. City & Classif. 2858130 Lic. # 328 Sq. Ft. 2489 No. No. Dw. Arch.- Engr., Size -Stories Units Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolit:on ❑ Address Tel. City Zip State Lic. # LICENSED CONTRACTOR'S`DECLARATION I hereby affirm that I am licensed under Drovisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and P,rofessions,Code, and my license is in full force and effect. SIGNATURE' DATE OWNER -BUILDER DECLARATION I hereby affirm that Pam exempt from the Contractor's License Law for the following reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a permit to construct, atter, improve, dernoLsh, 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 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 civil penalty of not more than live 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 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. H, however, the building or improvement is sold within one year of completion, the owner -builder wig have the burden of proving that he did not build or Inprove 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 builds 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 B. & P.C.- for this reason Date Owner WORKERS' COMPENSATION DECLARATION Worke1 hereby affirm that I have a certificate of consent to self -insure, or a certificate of r'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 (This section need not be completed H the permit is for one hundred dollars ($100) valuation or less.) I certify that in the performance or thg work for which this permit is issued, I shall not =any person in any manner so. as to become subject to the Workers' Compensation Laws of California. Date ; ) 'Owner, NOTICE To APPLICANT: H, 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 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.) 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 certity 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 slate 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 stimated Valuation 170.208 Minimum Setback PERMIT AMOUNT Plan Chk. Dep. Rear Setback from Rear Prop. Line Plan Chk. Bal. $ SQii , Const. FINAL DATE INSPECTOR Mech. 12127/88 33.00 Electrical Validated by: 113.52 Plumbing Validation: 111 .00 S.M.I. 11.94 Grading Driveway Enc. Infrastructure $3,829.68 1,91.4..84 �AAR '111rodit 1.914-84 } TOTAL S3.295.70 REMARKS 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 12127/88 Issued by: - Date Permit Validated by: Validation: • CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES IST FL. SO. FT. ® $ UNITS RADE ROUGH PLUMB. BONDING YARD SPKLR SYSTEM 2ND FL. SO. FT. ® FORMS ER ORS K ROUGH WIRING MOBILEHOME SVC. BAR SINK POR. SO. FT. ® Of If METER LOOP HEATING (FINAL) POWER OUTLET ROOF DRAINS GAR. SO. FT. ® TEMP. POLE GROUT DRAINAGE PIPING CAR P. SO. FT. ® FINAL INSP. WALL SO. FT. ® WATER SYSTEM DRINKING FOUNTAIN GRADING cu. yd. $ plus x$ =$ URINAL SO. FT. RAMING Z FINAL INSP. ESTIMATED CONSTRUCTION VALUATION $ t . I �p1)� Wi WATER PIPING NOTE: Not to be used as property tax valuation REMARKS: 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 LAUNDRYTRAY AIR HANDLING UNIT CFM SPARK ARRESTOR 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 I SULATIONISOUND 7 SO. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 11/4 c SEWAGE DISPOSAL SO.FT.GAR ® 3/ic HOUSE SEWER GAS PIPING PERMIT FEE PERMIT FEE In 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 ROUND PLUMBING UNDERGROUND A.C. UNIT COLL. AREA RADE ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMS ER ORS K ROUGH WIRING DUCT WORK ROCK STORAGE D. REINF. ]PAS(ROUGH Of If METER LOOP HEATING (FINAL) OTHER APPJEOUIP. REINF. STEEL (F NAL) TEMP. POLE GROUT WATER HEATER E ICE ` FINAL INSP. BOND BEAM WATER SYSTEM GRADING cu. yd. $ plus x$ =$ L MBER GR. 2 FINAL INSP. RAMING Z FINAL INSP. OFING t . I �p1)� Wi ��// C,� ( //, REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR G R. FIREWALL TH MESH I SULATIONISOUND 7 FINISH GRADING FI INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL