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04469 (SATT)i1:ir��+ L`,:;4 r • /II,, //,��,//��/; � •. ;,j ,— .moi Building Address - 9 T=4;leymd VvvI ICI 3�ixnriso Company Mailing' Address Pt . Desert . Zip 92260 Contractor National Mort4a Address; A Sam City ~- .. Zip State•Lic:�, t & Classif. Arch., Engr , ' - Designer s Address P.O. BOX 1504 78-105 CALLE ESTADO- . LA QUINTA, CALIFORNIA 92253 Tel .City ( Zip ( State Lic. # LICENSED CONTRACTOR'S 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 DATE } OWNER -BUILDER DECLARATION I hereby affirm that I am 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,' alter, Improve, demolish, or repair any structure, prior to its issuance also requires the applicant for such permit to rile 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 or the Business and Professions Code, or thathe is exempt therefrom, and the basis for the•aileged exemption. Any violation of Section 7031.5 by 'any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (8500). ❑ 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.' If, however, the building 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.) ❑ 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 I hereby affirm that 1 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. 0 Certified copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit Is for one hundred dollars (8100) 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., If, ,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. r' ) 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 c Name 1 Lender's 4Address This is a building permit when properly filled out, signed and validated, and is subject to expiration it work thereunder is suspended for 180 days. I car ify,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•Address City, State, Zip r 1 WHITE NANCE PINK - APPLICANT GREEN.- BUILDII �.-aC'.,. FI .: M, l.. ..:-.'. ,!/. _ti .r.._. a ._•lF.•li \_. .. _ n .. BUILDING: TYPE CONST. OCC. GRP. A.P. Number VGA bleat The Greens Legal Description' Project Description �� Pian ER ,y ZONE: BY: Minimum Setback Distances: Sq. Ft. , _ x1700— Size - . No. _2 Stories No. Dw., Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Side Street Setback from Center Line Side Setback from Property Line FINAL DATE INSPECTORIssued by: Date Permit ' Estimated Valuation $120 * 769 PERMIT Validation: AMOUNT Plan Chk. Dep. Plan Chk. Bal. 401., 27, Const. �o(; Mech. r,G, GOLDENROD ASSESSORS 39 a 00 Electrical F •? 7.0 Plumbing 105000. 4 S.M.I. 8.44 Grading Driveway Enc. Infrastructure $2#717.32 -massa credit 1,358w66 t«tC G4.±CRY:kC'+1aTE��:tC�%�Et! jL��Y�Q:#,tY , TOTAL 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 INSPECTORIssued by: Date Permit ' Validated by:, Validation: - r,G, GOLDENROD ASSESSORS OFFICE, HARD COPY FILE • F i CONSTRUCTION ESTIMATE ' �:� r. NO. ELECTRICAL FEES NO. PLUMBING FEES IST FL SO FT rp $� UNITS SLAB GRADE ROUGH PLUMB BONDING YARD SPKLR SYSTEM 2ND FL SO FT. a FORMS SEWER OR SEFTIC TANK ROUGH WIRING MOBILEHOME SVC. BAR SINK POR SO FTer GAS (ROUGH) METER LOOP HEATING (FINAL) OUTLET ROOF DRAINS GAR SO. FT. 0POWER TEMP. POLE GROUT DRAINAGE PIPING CAR P. SO FT. a FINAL INSP. BOND BEAM WATER SYSTEM'. DRINKING FOUNTAIN WALL SO. FT. (d _$ LUMBER GR. FINAL INSP. URINAL SU. FT. I$ ROOFING ESTIMATED CONSTRUCTION VALUATION $ WATER PIPING NOTE: Not to be used as property tax valuation FLOOR DRAIN MECHANICAL FEES VENTILATION WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASH ER(AUTONDISH) APPLIANCE DRYER FIREPLACE 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 1'A c SEWAGE DISPOSAL SO.FT.GAR 3/:c HOUSE SEWER ' CERT. OCC. 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 8 AIR COND. SOLAR SETBACK GROUND PLUMBING UNDERGROUND A.C. UNIT COLL. AREA SLAB GRADE ROUGH PLUMB BONDING HEATING (ROUGH) STORAGE TANK FORMS SEWER OR SEFTIC TANK ROUGH WIRING DUCT WORK ROCK STORAGE FOUND. REINF. GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APP.IEOUIP. 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 REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR, GAR. FIREWALL LATHING MESH INSULATION/SOUND FINISH GRADING I O,KL PB 10 ' CERT. OCC. FENCE FINAL INSPECTOR'S SIGNA-URESlINITIALS , GARDEN WALL FINAL 7d