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002892 (SFD)QW4 4_1 P.O. BOX 1504 Building 78-105 CALLE ESTADO Address 55-090 ►3 &i. LA QUINTA, CALIFORNIA 92253 Owner Mailing' Address 75-05 CbUntry C2XIb Drivia CityZip Tel. WS=t `Contractor Address City$-IZip . ITeI. cam' State Lia City & Classif. , 2ssno Lic. # . Arch., Engr., Designer Address Tel. City Zip State Lic. # - LICENSED CONTRACTOR'S DECLARATION . . I hereby affirm that l.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 i effect.. �. -- '�. F .r SIGNATURE r r`' DATE OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the'Contractor's 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 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 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 try 'any applicantfor a permit subjects the applicant to acivil penalty of not more 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 apply 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. If, however, the building or. improvement is sold within one year of completion, the ownar•builder will have the burden 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- struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Lawr 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 Contractor's License Law.) ❑ 1 am exempt.under Sec.- B. & 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 Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.) Policy No. Company O Copy is filed with the city. ❑ Certified copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars ($100)valuation or less.) — - - I certify that in the performance of the 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. C/ 002892 BUILDING: TYPE CONST. OCC: GRP. A.P. Number Legal Description PM Project Description MT PUM 14 A NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become .ZONE: Sq. Ft. MR' �� 1627' Size No. No. Dw. Stories Units New 5, Add ❑ Alter ❑ Repair ❑ Demolition ❑ Front Setback from Center Line Rear Setback from.Rear Prop. Line CONSTRUCTION LENDING AGENCY Side Street Setback from Center Line Estimated Valuation ,72*ii PERMIT- AMOUNT' Plan.Chk. Dep.. Side Setback from Property Line ' Plari.Chk. Bal. 380.44 Const.fiH.i7 ' Lender's Address Mech. INSPECTOR Electrical`i7+Y Plumbing7. expiration it work thereunder is suspended for 180 days. I S.M.I. 24- 147 Grading Issued by: Driveway Enc. I agree to comply with'all city and county ordinances and stare laws relating to building Infrastructure construction, and hereby authorize representatives -of this city to enter theabove mentioned for inspection %/ property purposes. �' Validated by: Signature of applicant �! Date �% s TOTAL 2.751..21 REMARKS - City, State, Zip A 7 2 6.1 2 6 X 7 5 1. 2 1 U 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 Labdr Code, you must forthwith 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 FINAL DATE INSPECTOR This is a building permit when properly filled out, signed and validated, and is subject to expiration it work thereunder is suspended for 180 days. I 24- 147 certify that I have read this application and state that the above information is correct. Issued by: Date Permit. I agree to comply with'all city and county ordinances and stare laws relating to building construction, and hereby authorize representatives -of this city to enter theabove mentioned for inspection %/ property purposes. �' Validated by: Signature of applicant �! Date �% s • Mailing Address Validation: - City, State, Zip A 7 2 6.1 2 6 X 7 5 1. 2 1 U HARD COPY CONSTRUCTION ESTIMATE '' ` NO. ELECTRICAL rMilk NO. PLUMBING FEES IST FL. SQ. FT. @ $ 2 ND FL. SQ. FT. @ POR. SQ. FT. @ GAR. SQ. FT. @ CARP. SQ. FT. WALL SQ. Ff. SQ FT @ ESTIMATED CONSTRUCTION VALUATION Is 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 �OUGH PLUMB. Y -021/-n — 1/ n FLOOR DRAIN MECHANICAL FEES HEATING (ROUGH) WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASH ER(AUTO)(DISH) APPLIANCE DRYER DUCT WORK GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED L4AS (ROUGH) t^ �% b / LAUNDRY TRAY AIR HANDLING UNIT CFM HEATING (FINAL) 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 WATER SYSTEM SQ. FT. @ c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SQ. FT. RESID @ 11/4 c SEWAGE DISPOSAL' f46FRAMING q— G --y SO.FT.GAR @ 3/ac HOUSE SEWER Tow 2Ap PRY (,,/A(( 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 ROUND PLUMBING UNDERGROUND A.C. UNIT COLL. AREA Ale SLAB GRADEZa �OUGH PLUMB. Y -021/-n — 1/ n BONDING HEATING (ROUGH) STORAGE TANK ��ORMS OWER OR SEP( y (t0UGH WIRING �/ G� I i DUCT WORK ROCK STORAGE ,FOUND. REINF._�% / (� �oCC 'd 1 L4AS (ROUGH) t^ �% b / METER LOOP HEATING (FINAL) OTHER APP./EQUIP. /I !44REINF. STEEL U GAS (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE , JNAL INSP. BOND BEAM WATER SYSTEM $ GRADING cu. yd. plus x$ _$ LUMBER GR.eINAL INSP.6--/rr'-F f46FRAMING q— G --y 4!4FKAL INSP.tl"— � , //CROOFINGo f,& (� rA� 1 Tow 2Ap PRY (,,/A(( REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR FIREWALL ''�//GAR. LL46 ATHING � ' MESH II�� 9UZINSULATION/SOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL