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04889 (SFD)P.O. BOX 1504 Building 49-010 Tit% „ Address ��LA QUINTA, CALIFORNIA 92253., Owner Mailing BUILDING: TYPE CONST. OCC. GRP. � „,. • Address 68-713 Perea ROA4 11. A.P. Number ��`ri La 'Q'ilinta „ CityZip Tel. cath dra'l City ,77.3 . Legal Description Contractor Project Description - Plan 1620. 'Phase LOt City - ; , Zip Tel. State Lic. & Classif. 7Q.7 City Lic. # , K ' . Sq. Ft. 1620 No.,,- No. Dw.; :. Size Stories Units ' Arch., Engr., _ Designer, New ❑ Add ❑ Alter O Repair ❑ Demolition t�4 ,_Address Tel. ' City ; . a., F State Lic. # �hr LICENSED CONTRACTOR'S DECLARATION -under I hereby affirmjthat;l'am licensed provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the.Busiriess and Professions Code, and my license is in -full force and effect. SIGNATURE' -- - V` •' 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 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 not more than five hundred dollars ($500). O 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 will have the burden of proving that he did not build or improve for the purpose of sale.) Estimated Valuation $4.1�} 4 422 ' PERMIT - .AMOUNT ' ' - Plan Chk. Dep. , Plan Chk. Bal. .5 $ 325422. Const. Q� Mech. �. • - Electrical •• .;i•��sQ Plumbing `} « ' O 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 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.) - O I am exempt under Sec. B. 8 P.C. for this reason S.M.I•-,. ,.•• , Grading _ Driveway Enc. Date Owner ,�\ .� �� Infrastructure 11108 • $Q_ ti 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. O Certified copy is hereby furnished. TOTAL- ti~�tt3-eca�► ' CERTIFICATE OF EXEMPTION FROM.- � WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars$100 or less.) dollars($100) valuation I certify that in the performance of thq work for which this permit is issued, 1 shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California REMARKS - W - e'.. • �• t y.pf'r�!': • Pi:t ! Date ' `Owner NOTICE TO APPLICANT: If, •• alter 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 rewked. '� ZONE: BY: - - t Minimum Setback Distances: • ' Front Setback from Center Line Rear Setback from Rear Prop. Line • CONSTRUCTION LENDING AGENCY Side Street Setback from Center Line I 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 f 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. t + I certify that I have read this application and state that the above information Incorrect. 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. y Signature of applicant - Date Mailing Address FINAL DATE - Issued bi : ' Validated by: Validation: ' INSPECTOR , Date Permit - tr _ " City, State, Zip ~' WHITE - FINANCE, PINK - APPLICANT, -GREEN - BUILDING, ,:._._. �_» .,-[-'_�'I ..- Sr'•. �__:-,i .�..�.,...... ..n.. -rt•: -..i .>-.�'- ... ri?:o .. _, r':' -a i.'.. GOLDENROD - ASSESSOR'S OFFICE, HARD COPY - FILE 'j .. a+..c•r... . -�.; J, I_�a. v7...%,2:,:. ._.._ •r:..:w,. ...-c:->'_fh_,. ,et_ ....,•Z. ._,.. CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES iST FL SO FT y $ UNITS FO GH PLUMB BONDING HEATING (ROUGH) STORAGE TANK YARD SPKLR SYSTEM 2ND FL SO FT. C ROUGH WIRING DUCT WORK ROCK STORAGE FOUND. REINF./ �11 MOBILEHOME SVC. BAR SINK POR SO FT. a REINF. STEEL GAS (FINAL) ',` P. POLE POWER OUTLET I ROOF DRAINS GAR SO. FT. Qt SERVICE FINAL INSP. BOND BEAM WATER SYSTEM FINAL INSP. DRAINAGE PIPING CAR P. SO FT. Ca LUMBER GR. / FRAMING "(/S ROOFING 3 'T/ � DRINKING FOUNTAIN WALL SO. FT. a VENTILATION URINAL SO. FT. (d ESTIMATED CONSTRUCTION VALUATION $ WATER PIPING NOTE: Not to be used as property tax valuation FLOOR DRAIN MECHANICAL FEES WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASH ER(AUTONDISH) APPLIANCE DRYER GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED MESH LAUNDRYTRAY AIR HANDLING UNIT CFM INSULATION/SOUND 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 FENCE FINAL SO. FT. g c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID t✓. c SEWAGE DISPOSAL SO.FT.GAR8r V c 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 8 AIR COND. SOLAR SETBACK GROUND PLUMBRJG UNDERGROUND A.C. UNIT COLL. AREA SLAB GRADE / FO GH PLUMB BONDING HEATING (ROUGH) STORAGE TANK FORMS r WER OR, ROUGH WIRING DUCT WORK ROCK STORAGE FOUND. REINF./ �11 GAS (ROUGH) �P METER LOOP HEATING (FINAL) OTHER APP.IEOUIP. REINF. STEEL GAS (FINAL) ',` P. POLE GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM FINAL INSP. �1 GRADING FINAL INSP. I �j �/� cu. yd. $ _plus_x$ _ $ LUMBER GR. / FRAMING "(/S ROOFING 3 'T/ � REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR' GAR. FIREWALL LATHING MESH INSULATION/SOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL