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003777 (BLCK)P.O. BOX 1504 No. 003777 Building 78-105 CALLE ESTADO Address 48--12.3 Calle Serena. LA QUINTA, CALIFORNIA 92253 Owner BUILDING: TYPE CONST. OCC: GRP." Mailing Address S '` A.P. Number 617-590--046 ..City Zip "Tel. - " ... .... '"" I Legal, Description TA oninte, Contractor 1 ' Project -Description 2a X '6 +�sbl_ 1a�l-ae oat . Address City _ Zip Tel.... State Lic. City & Classif.Lie. # Sq. Ft. No. No. Dw. Size Stories .,Arch., Engr:,"..... _. Units Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Address Tel. City Zip State _ Lie. # LICENSED CONTRACTOR'S DECLARATION ' I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 70 OO) of Division 3 of the Business and Professions Code, and my license is in full forcearia effect �!.✓ ��d'..f'�:. _. uf,/F/ i� SIGNATURE DATE OWNER -BUILDER DECLARATION Estimated Valuation I hereby affirm that I am exempt from the Contractor's License Law for the.following� w 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 file 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 a - 'Division 3 of the Business and Professions Code, or fhat.he'is exempt therefroin,'arid'the basis' -- - ' for the alleged exemption. Any violation 'of Section 7031.5 by 'any applicant for a permit Plan Chk.t Dep... - subjects the applicant to a civil penalty of not more than five hundred.dollars ($500): 0 I, as owner of the property, :or my employees with wages. as their sole compensation, will. Plan Chk..Bal. . do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and Const. q �.i� a � Professions Code: The Contractor's License Law does'not apply to an owner property who . 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 ElectflCal- • . 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- Plumbing struct the project. .(Sec. 7044, Business and Professions Code: The. Contractor's'Lrcense 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 contractors) licensed pursuant to the Contractor's License Law.) . - Grading O 1 am exempt under Sec. B. & P.C. for this reason Driveway Enc. Date " Owner Infrastructure WORKERS' COMPENSATION DECLARATION hereby -affirm that I 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.. O Certified copy is hereby furnished. TOTAL CERTIFICATE OF EXEMPTION FROM REMARKS- _ . WORKERS'.COMPENSATION INSURANCE (This section need not be completed it the permit is for one hundred dollars ($100) valuation ^ or less.) . .. .. .. . . I certify that in the performance.of thg work for which this permit is issued, I shall not.k --;_-employ any person in any manner'so as to become subject to the Workers' Compensation . v va�vra .� . v r.� . Laws of California. Date ' Owner NOTICE TO APPLICANT: If, after making this Certificate of Exemption you. should become ZONE: BY: subject to the Workers' Compensation provisions of -the Labor Code, you 'must foithwith - - comply with such provisions or this permit shall be deemed revoked. - 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 Lender's Address ' This is a building permit when properly filled out, signed and validated, and is subject to FINAL DATE INSPECTOR expiration if work thereunder Is suspended for 180 days. .- - 416/88 � ©�- _ I certify that I have read this application and state that the above information incorrect.. Issued,by- - Date 4T Permit agfee 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, State, Zip !„y HARD COPY CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SQ. FT. ® $ 2ND FL. SO. FT. POR. SQ. FT. ® GAR. SQ, FT. ® CAR P. SQ. FT. WALL SQ. FT. SQ FT ® ESTIMATED CONSTRUCTION VALUATION $ UNITS MOBILEHOME SVC. POWER OUTLET YARD SPKLR SYSTEM BAR SINK ROOF DRAINS DRAINAGE PIPING DRINKING FOUNTAIN URINAL WATER PIPING NOTE: Not to be used as property tax valuation BONDING FLOOR DRAIN MECHANICAL FEES FORMS WATER SOFTENER VENT SYSTEM FAN EVAP.000L HOOD SIGN WASH ER(AUTO)(DISH) APPLIANCE DRYER GAS (ROUGH) GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED OTHER APPJEQUIP. LAUNDRY TRAY AIR HANDLING UNIT CFM TEMP. POLE 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. SO. FT. RESID @ 11/4 c SEWAGE DISPOSAL SQ.FT.GAR ® 3/ac HOUSE SEWER REMARKS: 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. WREINF. STEEL L! �.� GAS (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM V— 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 INSPECTIONV—/5-�v CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS_ GARDEN WALL FINAL