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04952 (SFD)i� 17,E � u�i'IGiCv 2 P.O. BOX 1504 N Q . 04952 Building 78-105 CALLE ESTADO Address 54-995 Shoal Creek LA QUINTA,.CALIFORNIA 92253 ---••-• Sa�fc�:f>L Cw1�s�a>zv Mailing Address A2-600 Conk qrrpipt �yylop. O City Zip Tel. 4 Contractor Address Y W. Zip ITel.' State Lic. City &Classif. 288130 Lic.# 328 Arch., Engr., Designer Address Tel. City (Zip (State Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing with Section 7000) of ivision 3 of the Business and Professions Code, and my license is in full force and effect A . ir SIGNATURE "" Y DATE OWNER -BUILDER DECLARATION 1 hereby affirm that 1 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, after, improve, demolish, or repay 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 notmore 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 appy 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. d, however, the building Of improvement is sold within one year of completion, the owner -builder will have the burden of proving that he did not build of improve for the purpose or safe.) ❑ 1,'as owner of the property, am exclusively contracting with licensed contractors to con- 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 such projects with a contractor(s) licensed pursuant to the Conlmctor's license Law.) ❑ 1 am exempt under Sec. R_ & P.C. for this reason Date Owner _ WORKERS' COMPENSATION DECLARATION I 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 fumished. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed ff the permit is for one hundred dolWs ($100) valuation or fess.) I certify that in the performance of thle work for which this permit is issued, I shall not employ any person in any manner sous to become subject to the Workers' Compensation Laws of California. Date owner NOTICE TO APPLICANT: ff, after malting this Certificate of Exemption you should become subject to the workers' Compensation provisions of the Labor Code, you must forthwith comply with such provfsfons or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, CM Code.) Lenders Name Lenders 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. 1 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 BUILDING: TYPE CONST. OCC..GRP.: A.P. Number ACIA Ra+ftr '4"r..irot 20717a8 Legal Description Project Description Dih A its 1 TAS _ R11— 7r11 Sq. Ft. 1548 No. No. Dw. Size Stories Units" New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. S 3 70-:58 Const. 455.50, Mech. AB Ota. 34,00 1 Electrical A5.114 Plumbing R7.50 S.M.I. n, Grading Driveway Enc. Infrastructure $2.442.28 1,221.t4, S p a t1.221.14 TOTAL S t e 24 2: 7,? REMARKS .,�.,t��i�A:'�E�,t��,�h'f'A9!',�fit,�,•�'�"'�98Y'9.1x rot �.ff ZONE: BY: Minimum Setback Distances: Front Setback from Center Line Rear Setback from Rear Prop. Line Side Street Setback from Center Line Side Setback from Property Line FINAL DATE INSPECTOR Issued by: Date 12/$J88Permit Validated by: Validation: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST 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. ® TET. LE GROUTT DRAINAGE PIPING CAR P. SQ. FT. ® FINAL INSP. BOND BEAM WATER SYSTEM DRINKING FOUNTAIN WALL SQ. FT. ® =$ LUMBER GR. FINAL INSP. FRAMING URINAL SQ. FT. ESTIMATED CONSTRUCTION VALUATION $ REMARKS:- EMARKS:VENTILATION WATER PIPING NOTE: Not to be used as property tax valuation FLOOR DRAIN MECHANICAL FEES WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED SPARK ARRESTOR LAUNDRY TRAY AIR HANDLING UNIT CFM GAR. FIREWALL 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 FI ISH GRADING SO. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SQ. FT. RESID ® 11/4 c SEWAGE DISPOSAL SQ.FT.GAR @ V4c HOUSE SEWER 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 APPJEOUIP. REINF. STEEL GW(FINAL) All TET. LE GROUTT 99ER HEATERS.- RVICE .Z FINAL INSP. BOND BEAM WATER SYSTEM GRADING cu. yd. $ plus x$ =$ LUMBER GR. FINAL INSP. FRAMING FINAL INSP. ROOFING REMARKS:- EMARKS:VENTILATION VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATIONISOUND FI ISH GRADING F,I14AL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS ' GARDEN WALL FINAL