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06704 (RC)Address 77-975 Tanpleo Owner Cheater Dora Tihf *4 4 Q" P.O. BOX 1504 78-105 CALLE ESTADO LA QUINTA, CALIFORNIA 92253 Mailing Address P. ©. Box 489 City Zip Tel. Era Quints 192253 1 564-8596 Contractor Zip Tel Desert State Lic. City & Classif. Lic. # Arch., Engr., Designer Address Tel. City(Zip I State Lic. # LICENSED CONTRACTOR'S DECLARATION Iherebaffirtn:that, I am licensed under provisions of Chapter 9 (commencing with Section 700%) on 3'61the Business and Profess ions Code, and my license is in full force and SIGNATURE£ Y "e _. "". or 1w DATE OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractors License Law for the following reason[ (Sec. 7031.5,Busimess and Professions Code: Any city or county which requires a PernT to construct, after, improve, demolish, or repair any structure, prior to its issuance also requires the rsuant to the rovsiors applicant for such Contractor's License law, Channit to file a pter 9e statementthat he i� �tioW7000) of avision 3 of the Business and Professions Code, or that. he is exempt eretmm, and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit suWcts do applicant to a crvilpenally of not more than fire hundred dollars ($500). O 1, 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 Cade- The Contractors License Law does not apply to an owner of property who bid& or improves thereon and who does such work himself or through his own employees, provided Oat such improvements are not intended or offered for sale. If, however, the building or irpmvement is sold wilKn one year of completion, the owner -builder will have the burden of provig that he dd riot build or improve for the purpose of sale.) ❑ 1, 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 protects wO a contractorfs) licensed pursuant to the Contractor's license Law.) ❑ 1 am exempt under Sec B. & P.C. for this reason Date IOwner WORKERS' COMPENSATION DECLARATION 1 hereby affirm that I have a certificate of consent to self -insure, or a certificate of Workers 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 (rids section need not be completed if the pemtit is for one hundred dollars ($100) valuation or less_) I certify that in the perfomance 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: 11, after making this Certificate of Fxenption you should become subject to the Workers' compensation provisions of the Labor Code, you must forthwith campy With such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY 1 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.) Lenders Name Lender's Address This is a building permit when properly filled out, signed and validated, and is subject to expiration if work Umereunder 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 laves relating to building constfurdork and hereby authorize representatives -of this city to enter the above, mentioned property for inspection purposes. Signature of applicant Date Mailing Address City, State, Tip No. 06704 BUILDING: TYPE CONST. OCC: GRP. A.P. Number 773-078-028 Legal Description Project Description 8 Interior Mil , " - w chamm exterior door. - Sq. Ft. No. No. Dw. Size Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition El PERMIT Plan Chk. Dep. Plan Chk. Bal. Const. Mech. Electrical AMOUNT S.M.I. Grading Driveway Enc. Infrastructure TOTAL REMARKS tt< A?4k ov 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 1.2/4/89 Issued by: Date Permit Validated by: Validation: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES IST FL. SQ. FT. ® $ UNITS SLAB GRADE ROUGH PLUMB. BONDING YARD SPKLR SYSTEM 2ND FL SQ. FT. ® FORMS SEWER OR SEPTIC TANK ROUGH WIRING MOBILEHOME SVC. BAR SINK POR. SQ. FT. ® GAS (ROUGH) METER LOOP HEATING (FINAL) POWER OUTLET ROOF DRAINS GAR. SQ. FT. ® TEMP. POLE GROUT DRAINAGE PIPING CAR P. SO. FT. ® FINAL INSP. BOND BEAM WATER SYSTEM DRINKING FOUNTAIN. WALL SQ. FT. ® =$ LUMBER GR. FINAL INSP. URINAL SQ. FT. @ 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(AUTO)(DISH) APPLIANCE DRYER FIREPLACE GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED LAUNDRY TRAY 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. SQ. FT. ® c BATH TUB SQ. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SQ. FT. RESID ® 11/. c SEWAGE DISPOSAL SO.FT.GAR ® 3/ic HOUSE SEWER CERT. OCC. GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEE MECH.FEE PL.CK.FEE 7ONST. 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 APPJEOUIP. 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 SIGNATURESJINITIALS ' GARDEN WALL FINAL