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05765 (RPL)Building Address 4• Owner a ce• P.O. BOX 1504 N o . 78-105 CALLE ESTADO LA QUINTA, CALIFORNIA 92253 Mailing BUILDING: TYPE CONST. - OCC: GRP... Address stum _ A.P.. Number Citi. QUINTA T�2253 Legal Description LOT .9 355 A city PALK W State Lic. & Classif.cs Arch.; Engr., Designer Address' LS'B �. Project DescriptionL & SPAVWE WAY 01 N, Tel.. 346-76335 _ City Lic. # Sq. Ft.575 v No. Size Sto Tel. •I No. Dw. Units New ❑ Add ❑ Alter ❑ Repair ❑ r ' -Demolition ❑ City Zip State " Lic: # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions,of Chapter 9 (commencing with Section 7000) ofrDivision 3 of the Business{ and-Pro(fessiods Code, and my license is in full force and effecL »G.. i t 1 Il. 1.:. 1 . / • SIGNATURE i fy-' I—IJr 't✓_ 'DATE- OwkEi1-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 pemdt to construct, after, 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 Dtvision 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 penally of not more than rive hundred dollars (8500). ❑ 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 Estimated Valuation 13,000• 1 ' PERMIT AMOUNT - - Plan Chk. Dep.'s Plan Chk. Bal. Const. �3 �� • McCh .. • •+ 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 _ Electrical q"'{�� • or improvement is sold within one year of completion, the owner -builder will have the burden -. of proving that he did not build or Improve for the purpose of sale.) Plumbing ❑ 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. "-- R. & P.C. for this reason S.M.1. .�� •• Grading Driveway Enc. s Date Owner Infrastructure a 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 thecity. ❑.Cer�ified co ty. py is hereby furnished. r 1 - Fi !_• TOTAL -7: CERTIFICATE COMPENSATION IN UROM - . - WORKERS' COMPENSATION INSURANCE AN (This section need not be completed ff. the pemrft 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 =any person in any manner so as to become subject to the Workers' Compensation Laws of California REMARKS . �,_ }r'! x:,._ �.{� .� c.`Yt�., +z _s •.��' ir3 a..� _' .. .. '��'`, 10T, • ?vS1r}J'b .t im-t. 1. 14,411 Date • Owner NOTICE TO APPLICANT: ff. after making this Certificate 'of Exemption you should become • subject to the Workers' Compensation provisions of the Labor Code, you must forthwith complywithsuchProvisionsorthisPermitshallbedeemedrevoked. - ZONE: - BY: - Minimum Setback Distances: Front Setback from Center Line Rear Setback from Rear Prop. Line ' CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permif is issued. (Sec. 3097, Civil Code.) Side Street Setback from Center Line A Side Setback from Property Line Lender's Name Lender's Address FINAL DATE INSPECTOR 51! 1i1 89 - - This'is a building permit when properly filled out, signed and validated, and is subject to expiration it work thereunder is suspended for 1130 days.. - I certify that 1 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.' Issued by: Date Permit Validated by: .Signature of applicant Date �- Mailing Address Validation: - City, -State, Zip CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES IST FL. SO. FT. ® $ UNITS SLAB GRADE IN ROUGH PLUMB. Y ��ING YARD SPKLR SYSTEM 2ND FL SO. FT. FORMS SEWER OR SEPTIC TANK GH WIRING. MOBILEHOME SVC. 'BAR SINK POR. SO. FT. ® GAS (ROUGH) b ER LOOP HEATING (FINAL) POWER OUTLET ROOF DRAINS GAR. SO. FT. ® GAS (FINAL) TEMP. POLE GROUT DRAINAGE PIPING CAR P. SO. FT. ® FINAL INSP. BOND BEAM DRINKING FOUNTAIN. WALL SO. FT. LUMBER GR. FINAL INSP. FRAMING URINAL SO. FT. @ `� lz_2 Y /S / ESTIMATED CONSTRUCTION VALUATION $ REMARKS: 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, TEMIPERM LAVATORY HEATING SYSTEM FORCED GRAVITY AMPERES SERV ENT SHOWER BOILER. B.T.U. SO. FT. ®c BATH TUB FINISH GRADING SO. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 11/4 c SEWAGE DISPOSAL SO.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 RGROUND A.C. UNIT COLL AREA SLAB GRADE IN ROUGH PLUMB. Y ��ING HEATING (ROUGH) STORAGE TANK FORMS SEWER OR SEPTIC TANK GH WIRING. DUCT WORK ROCK STORAGE FOUND. REINF. GAS (ROUGH) b ER 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 `� lz_2 Y /S / REMARKS: VENTILATION FIRE ZONE ROOFING: FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATION/SOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATL"RESIINITIALS GARDEN WALL FINAL 1