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00290044 Q944.. P.O. BOX 1504 No Building 78-105 CALLE ESTADO Address LA QUINTA, CALIFORNIA 92253 Owner Address . 75—,00J Cbtwt City lZip Contractor . Address BUILDING: TYPE CONST. OCC: GRP. A.P. Number Legal Description Project Description PMNM FE -15 A PLM 2 C NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become 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 Ihereby affirm that there is at construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code.) Lender's Name Lender's Address This is a building permit when properly filled out, signed and validated, and is subject-ta expiration it 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 �/ =r 'rte^� Date Mailing Address City, State, Zip % HARD COPY 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' 2--4-87 Permit Validated by: Validation: A?292 2 10 ib4&8(1 CR ' City sam Zip Tela State Lic. & Classif. 28 �3Q City Lic. # 32R err $ Sq. Ft. 124 Size No. No. Dw. Stories Units • --Arch., Ehgr.; - Designer New CY, Add ❑ Alter ❑ Repair ❑ Demolition ❑ Address Tel. City Zip State Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that.l em licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3;oi.the Business and CProfessions Code, and my license is in -full force'and effect. .. - SIGNATURE- 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, after, improve, demolish, or repair any structure, prior -to its issuance also requires the applicant for such permit to Ne 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 or Section 7031.5 by. 'any applicant for a. permit ' subjects the applicant to a'civil penalty of not more than five -hundred dollars ($500). ❑ 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 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 owner -builder- wi# ,have the burden of proving that he did not 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 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 Contractor's License Law.) ❑ I am exempt under Sec. B. tx P.C. for this reason - Estimated Valuation f n�! y�)�r�'2:a•ini r PERMIT' �i. AMOUNT - Plan Chk. Dep. Plan Chk. Bal. '�'�Friiii 1y.�l�yy -♦ V . JLI Const. 4.55.50 Mech. �, Q� • Electrical CC �7�-#• Plumbing 87.50 S. M. 1. 7»� Grading Driveway Enc. Dale owner Infrastructure 1,628.1.8 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 ❑ 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 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 — Owne*r TOTAL 2.648.RO REMARKS ' NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become 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 Ihereby affirm that there is at construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code.) Lender's Name Lender's Address This is a building permit when properly filled out, signed and validated, and is subject-ta expiration it 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 �/ =r 'rte^� Date Mailing Address City, State, Zip % HARD COPY 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' 2--4-87 Permit Validated by: Validation: A?292 2 10 ib4&8(1 CR CONSTRUCTION ESTIMATE NO. ELECTRICAL FE NO. PLUMBING FEES IST FL. SQ. FT. ® $ UNITS ��SLAB GRADE 2ND FL. SQ. FT. BONDING,_?—_T—F 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 APP.IEOUIP. DRINKING FOUNTAIN SQ. FT. ® TEMP. POLE URINAL ESTIMATED CONSTRUCTION VALUATION $ GROUT WATER PIPING NOTE: Not to be used as property tax valuation FINAL INSP. 2 FLOOR DRAIN MECHANICAL FEES WATER SYSTEM WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER !GZFRAMING I _ GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED TO wl A b ,&� W( '^ �G `S/�jl , 1 V l� LAUNDRYTRAY 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 ® 11/4 c SEWAGE DISPOSAL LATHING 501 SQ.FT.GAR ® 3/ac HOUSE SEWER MESH GAS PIPING PERMIT FEE p WL INSULATION/SOUND 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 .�� /KGROUND PLUMBING :7-3—S' UNDERGROUND A.C. UNIT COLL. AREA ��SLAB GRADE j;4;OUGH PLUMB. 7'12-7- BONDING,_?—_T—F HEATING (ROUGH) STORAGE TANK �/ FORMS J� EWER OR SEPT �OUGH WIRING j DUCT WORK ROCK STORAGE —/—,F,1 G4FOUND. REINF.1d ! Oi! I GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APP.IEOUIP. REINF. STEEL J GAS (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. 2 BOND BEAM WATER SYSTEM GRADING —Cu. yd. $ plus x$ _$ LUMBER GR. FINAL INSP. !GZFRAMING I _ FINAL INSP. v ILl ROOFING (�-1�.. a� TO wl A b ,&� W( '^ �G `S/�jl , 1 V l� REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING 501 MESH p WL INSULATION/SOUND FINISH GRADING �INAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURES/INITIALS GARDEN WALL FINAL