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001960 (BLCK)414 P.O. BOX 1504 N o . Building 78-105 CALLE ESTADO Address 51-407 AverA& M_-' . LA QUINTA, CALIFORNIA 92253 Owner Mailing Address City Zip uvouinta - T Contractor . Address . •' . City State Lic. & Classif. -Arch., Engr., Designer ITe1. t - City Lic. # BUILDING: TYPE CONST. OCC: GRP. A.P. Number "~085-023 Legal Description Project Descrip@tiioonqq��,,� . - 385 line ftm of 'Mint highAvitk van. Sq.' Ft. No. Size • Stories No. Dw, Units New:M -• Add ❑ Alter ❑. Repair ❑ Demolition ❑ Address Tel. City State Tip Lic. # " LICENSED CONTRACTOR'S DECLARATION hereby affirm that I am licensed under provisions. of Chapter' (commencing with Section 7000) of Division 3 of the Business and ProfessionsCode, 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�� EStlmated Valuation • reason: (Sec. 7031.5,Business and Professions Code: Any .city, or county which requires*a - PERMIT AMOUNT Y -, permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance also- , -i, requires the applicant for such. permit to rile a signed statement that -he 'is licensed pursuant to- - the provisions or 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 or not more: than'five hundred dollars ($500). O I, as owner of the property, or my employees with wages as.their sole compensation, will Plan Chk.: Dep. • ' .. - Plan Chk. Bal.. 49.42 . Const. 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 McCh. - - - 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.) Electrical , " -Plumbing ' ❑ I, as owner of the property, am exclusively contracting with licensed contractors to con- struct the -project. (Sec. 7044, Business and Professions Coder The Contractor's License Law does not apply -to an owner or property who builds or improves. thereon, andwho contracts for S.M:I'. . �,� • • such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) - - 0.1 amexempt under Sec. .B..& P.C. for this reason Grading - Driveway Enc. - Date Owner ::Q �T n 1 .f t y_ Infrastructure WORKERS' COMPENSATION DECLARATION ' I hereby affirm that I' have a certificate of consent -to self -insure, or a'certificate, of :.r Worker's Compensation Insurance, or a certified copy thereof: (Sec. 3800, Labor Code.) Policy No. Company ❑ Copy is filed.with,the city. , .O Certified copy is hereby furnished. TOTAL 123,52 _ CERTIFICATE OF EXEMPTION FROM WORKERS'.COMPENSATION INSURANCE ,. REMARKS, - - . (This section need not be completed if the permit is for one hundred dollars (5100) valuation or less.). .. I certify that in the performance of lhg 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_L' ' Ownei NOTICE TO APPLICANT: If, after making this Certificate of Exemption'. you should become subject to the' Workers" Compensation provisions of* the Laboi Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. ZONE: BY: Minimum Setback Distances: .. ' Front.Setback from Center Line Rear Setback from Rear Prop. Line CONSTRUCTION LENDING AGENCY Side Street Setback from Center Line 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 FINAL'DATE INS.�r5 PECTOR 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 certify that I have read this application and state that the above information is correct.. ' '1 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 - IA"' rt - +1 F n .l.i Date Mailing Address / t Issued by- Validated by: Validation: A 3 6 1 9. y 4 ' DateR permit 12 23 2352. D, city, State, Zip f HARD COPY CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SQ. FT. ® $ UNITS SLAB GRADE 2ND FL. SQ. FT. BONDING YARD SPKLR SYSTEM POR. SO. FT. ® MOBILEHOME SVC. BAR SINK GAR. SQ, FT. ® POWER OUTLET ROOF DRAINS CARP. SQ. FT. GAS (ROUGH) DRAINAGE PIPING WALL SO. FT. ® OTHER APP./EQUIP. DRINKING FOUNTAIN SQ FT ® TEMP. POLE URINAL ESTIMATED CONSTRUCTION VALUATION $ GROUT WATER PIPING NOTE: Not to be used as property tax valuation FINAL INSP. FLOOR DRAIN MECHANICAL FEES WATER SYSTEM WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER FINAL INSP. GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED LAUNDRYTRAY AIR HANDLING UNIT CFM IKITCHEN 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 BAH TUB SPARK ARRESTOR SQ. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 1 1/a c SEWAGE DISPOSAL SQ.FT.GAR ® 3/ac HOUSE SEWER MESH 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 FOUND. REINF. (p� pZ' 1 O v GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APP./EQUIP. REINF. STEEL GAS (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM G WATER SYSTEM GRADING cu. yd. $ plus x$ . =$ LUMBER GR. FINAL INSP. FRAMING FINAL INSP. ROOFING — ' ) � / �p/ Q . REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATION/SOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATOR=SIINITIALS, GARDEN WALL FINAL 'Am QgLKgR 0.0. ®ox 206 CATHEDRAL CITY, CA 92234 Jim WEUM LAND & CONSTRUCTION SURVEYOR • SURVEYING • MAPPING /LiRS �P cSiiv soy . X01 -Cors 9f,/0'0 '0ZAe 6 7- s�BiB�67 $MEET NO. OF CALCULAT$D BY `�r— DATE.T/�`,/ CHlCKED 9Y My DATE FORM 204 Avs6bl• hese ZN IMC. Tornssnd. Mass olQo