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04354 (SATT)i!'�GH,rGv Y �.. •fir �r. t44 P.O. BOX 1504 's - Building 78-105 CALLE ESTADO Address 55-429 Tanglewood _ LA QUINTA, CALIFORNIA 92253 Owner Mailing Address 75'"045 Countzi Cluli . Drive.__,, City Zip Tel. Palm De5e 92260 Contractor National Mortgage Address ' City REMARKS WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars ($100) valuation Tel. State Lic. Of less.) City & Classif. employ any person in any manner so as to become subject to the Workers' Compensation Arch., Engr., Laws of California. Designer Date Owner Address NOTICE TO APPLICANT. fl, after making this. Certificate of Exemption you should become Tel. ` subject to the o•Workers'..Compensation provisions of the'•Labor. Code, you must -forthwith ^. "� T Distances: •- Zip BUILDING: -TYPE CONST. OCC. GRP_. , '�1.a' • A:P'Number^ � . �? »IG�'E3:'�t "°" �'�'14�t �reAd a Ilt~3 Legal Description Project Description ��`�� .« �� • ' I y Lic. # • - � - • 'Sq. Ft. Size City I Zip I State Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that 1 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 ':t.'{;� yl hereby affirm that I am exempt from the Contractor's License Law for the following .reason: (Sec. 7031.5,Susiness and Professions Code: Any city or county which requires a permit to construct, after, improve, demolish, 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 five 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. 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.) 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 Contractors 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.) ❑ 1 am exempt under Sec. B. & P.C. for this reason Date Owner WORKERS' COMPENSATION DECLARATION I hereby affirm that l 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 O Copy is filed with the city. ❑ Certified copy is hereby furnished. No. r � � No. Dw.• �• Stories Units. New ❑ Add ❑- Alter ❑ Repair ❑ Demolition ❑ PERMIT Plan Chk. Dep. Plan Chk. Bal. Const. Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure Was cult TOTAL r OV 11 0 yWJu AMOUNT �3t4th'Yr7y1 �3{9*00 64474 87.00- 6169 7.00 6 f169 39 7 34 CERTIFICATE OF EXEMPTION FROM • REMARKS WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars ($100) valuation 'tF'-`l3Lo�s7''��*rr5r""i.,�r„"�$ 10 Of less.) I certify that in the performance of thq 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. fl, after making this. Certificate of Exemption you should become ZONE: - BY: - - subject to the o•Workers'..Compensation provisions of the'•Labor. Code, you must -forthwith ^. "� Minimum Setback Distances: •- comply with such provisions or this permit shall be deemed revoked. ^ ' • ^ _ Front Setback from Center' Line— ine r Rear Setback from Rear Prop. Line ` Rear • 'CONSTRUCTION LENDING AGENCY = .� • t, Side StreefSetbacKfrom Center Line ` I hereby affirm that there is a construction lending agency for the performance of the-' r •_1 work for which this permit is issued. (Sec. 3097, Civil code.) , • - Side Setback from Property Line • Lender's Name Lender's Address •' FINAL DATE i. INSPECTOR • 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. 7/22/88 ” I certify that I have read this application and stale that the above information is correct.- -Issued by: Date Permit 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. Validated by: ., Signature of applicant ' Date Mailing Address Validation: City, Slits, Zip - '. WHITE -FINANCE, PINK -APPLICANT, GREEN -BUILDING, GOLDENROD =ASSESSOR'S OFFICE, HARD COPY -FILE CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES IST FL SO FT h $ UNITS SLAB GRADE ROUGH PLUMB BONDING YARD SPKLR SYSTEM 2ND FL SO FT. g FORMS SEWER OR SEPTIC TANK ROUGH WIRING MOBILEHOME SVC. BAR SINK POR SO FT. at GAS (ROUGH) METER LOOP HEATING (FINAL) POWER OUTLET ROOF DRAINS GAR SO. FT. Of TEMP. POLE GROUT DRAINAGE PIPING CAR P. SO FT. e FINAL INSP. BOND BEAM WATER SYSTEM DRINKING FOUNTAIN WALL SO. FT. Q -$ LUMBER GR. FINAL INSP. URINAL SO. FT. 0 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 WASHER(AUTOXDISH( 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 g 1+A c SEWAGE DISPOSAL SO.FT.GAR q 4c HOUSE SEWER CERT. OCC. GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEE MECH.FEE 'PL.CK.;!EE 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 SEPTIC 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 INSULATIONISOUND FINISH GRADING N'A N CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL