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003553 (BLCK)•3 .Building > Address 52-685 Avenida � Owner ill$aM S. Long Mailing Address 52-703 Avenida City Zip p LA ' rota . • CA -q2254 Contractor. Address 44 P.O. BOX 1504 NQ. 003553 78-105 CALLE ESTADO LA QUINTA, CALIFORNIA 92253 BUILDING: TYPE CONST. OCC: GRP. �TElaaG A:P.,Number 773-294-021' Tel. - rrF�dufl•!' Legal Description Project Description s ' X -69 wood Fertele �� aunt' uus l.erllu4altl or exemption you snouts oecome 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'cohslruction lending agency for the performance of the work for which this permit is issued. (Sec: 3097, Civil Code.) - Lenders 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 certify 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 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 Issued by: Date Permit Validated by Validation: HARD COPYI T City ., Zip Tela .. State Lic. City & Classif. Lic. # Sq. Ft. No. No. Dw. Size = • •. - Stories Units Arch., Engr. Designer New ❑ Add ❑ Alter ❑- Repair ❑ . Demolition Address 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 EStlinated Valuation I hereby affirm that I am exempt from the Contractors 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 repa)r any structure,. prior to its issuance also - requires the applicant for such permit to rile a signed statement that he is licensed. pursuant to PERMIT - - - AMOUNT the provisions of the Contractor's License.,Law, Chapter 9 (commencing with Section 7000) of - - ' Division 3 of the Business and Professidns:'Code, or thaChe-is exempt therefrom; and the. basis . - �Chk. - for the alleged exemption. Any violation of Section 7031.5 by 'any applicant for a permit Plan Dep. - • subjects the applicant to a civil penalty of not more than five hundred dollars ($500). - Plan Chk. Bal. ' ❑ I, as owner of the property, or my employees with wages as.their sole compensation, will v do the work, and the structure is not intended or offered for sale. (Sec. 7044; Buisness and �4A t�ta • Professions Code: The Contractor's License Law -does not apply,to an owner of property who -COnSt. - eG1t Vit builds or improves thereon and who does such work himself or through his own employees,. Mech. ' . 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 Electrical' - •' - - of proving teat 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- Plumbing' ' 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 S.M:I. - such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) - Grading ❑ I am exempt under Sec..B. B. 8 P.C. for this reason Driveway Enc. Date — !Y 14 a owner f /r �� � * ,� _ �• ---� ^9 Infrastructure WORKERS' COMPENSATION DECLARATION ' f ' I hereby affirm that'I have a certificate of'consent to self -insure, 'or a• certificate bf ' Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor -Code.) Policy No. Company .O Copy.is filed with the city. .O Certified copy is hereby. furnished. .. TOTAL $20.00 CERTIFICATE OF EXEMPTION FROMREMARKS WORKERS' COMPENSATION INSURANCE (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 the work for which this permit is issued, 1 shall not employ any person in any manner so alto become subject to the Workers' Compensation ' �� aunt' uus l.erllu4altl or exemption you snouts oecome 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'cohslruction lending agency for the performance of the work for which this permit is issued. (Sec: 3097, Civil Code.) - Lenders 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 certify 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 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 Issued by: Date Permit Validated by Validation: HARD COPYI T CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES IST FL. SQ. FT. ® $ UNITS SLAB GRADE 2ND FL. SQ. FT. Q BONDING YARD SPKLR SYSTEM POR. SQ. FT. ® MOBILEHOME SVC. BAR SINK GAR. SQ. FT. ® POWER OUTLET ROOF DRAINS CAR P. SQ. FT. GAS (ROUGH) DRAINAGE PIPING WALL SQ. FT. OTHER APPJEQUIP. 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.000L HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER FINAL INSP. 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, TEM/PERM LAVATORY HEATING SYSTEM FORCED GRAVITY AMPERES SERV ENT SHOWER BOILER B.T.U. SQ. FT. ®c BATH TUB SQ. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 1+/a c SEWAGE DISPOSAL GAR. FIREWALL SQ.FT.GAR ® 3/ac HOUSE SEWER LATHING 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. GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APPJEQUIP. 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 FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS. GARDEN WALL FINAL