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04895 (SFD)' _ i. uujttc� • 't' w P.O. BOX 1504 Building,�� 78-105 CALLE ESTADO ��Tango AddressLA QUINTA, CALIFORNIA 92253 a Owner 1; ,- Bsrc6n Development Address? 69'-713 �'�Irez RoadCity Zip 7-01 l. M•y fikt adral City 93234 773-9024 Contractor Address. City' rw. ' lZip I Tel. State Lic. & Classif. 33 707 7 Arch., Engr., Designer Address . -v BUILDING: TYPE CONST. OCC. GRP. A.P.,Number Fare Lis Quluta Legal Description Project Description P 22,i2 s Phase I ^- Lot �l I� City Lic. # !� _ _ Sq. Ft. 2222' NO... . Size Stories el. CityI Zip I State Lic. # �•` LICENSED CONTRACTOR'S DECLARATION I hereby affirm that 1, 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 effect. .;„r= ... f ''r • rt t"S� :i 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 New ❑ Add ❑ Alter ❑ Itstlmatea valuation 2 No., Dw. i Units Repair ❑ Demolition ❑ permit to construct, after, improve, demolish, or repair any structure, prior to its Issuance also -AMOUNT requires the applicant for such permit to file a signed statement that he is licensed pursuant to PERMIT ' ' 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 Plan Chk.•Dep. _ subjects the applicant to a civil penalty of not more than five hundred dollars (E500). Plan Chk. Bal. , y - 64 O I, as owner of the property, or my employees with wages as their sole compensation, will _ . + + p do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and Const. 4 t%+� 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, Mech. P that such improvements are not intended or offered for sale. If, however, the building - , orimprovement is sold within one year of completion, the owner -builder will have the burden Electrical -, of proving that he did not build or improve for the purpose of sale.) 01, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing _ ► - struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law ,; -�t - does not apply to an owner of property who builds or improves thereon, and who contracts for S.M.I. ..l 7 •.cif d such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) Grading . O 1 am exempt under Sec. B. & P.C. for this reason Driveway Enc. Date Owner Infrastructure 2 1523 + 3 WORKERS' COMPENSATION DECLARATION 1 , 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 a` _ O Copy is filed with the city. ❑ Certified copy is hereby furnished. i.. TOTAL�if�eE? / CERTIFICATE OF EXEMPTION FROM REMARKS WORKERS' COMPENSATION INSURANCE ,(This section need not be completed If the permit is for one hundred dollars ($100) valuation • A6i%tsrdPl,7Y:':i„R z�,;a,.na,;;,'�,,rt._.-i.Fx rF't;e1+:=„i, •�ir.t^3 or less.) •. I certify that in the performance of thg work for which this permit is issued, I -shall not _,t{\�'''�'WL;.3i'4F1'�C'i' ,1,i°`AiY^i: YKiIY <E :`�•' ''+.wK9w;.V •d"i "``^ employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date Owner ,NOTICE TO APPLICANT: If, after making- this Certificate of Exemption you should become ZONE: BY - subjectl to the Workers' Compensation provisions of. the Labor 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 ear Prop. Line ' *� CONSTRUCTION LENDING AGENCY Side Street Setback from Center Line Ihereby 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 ` - , • 4 Lender's Address � - FINAL DATE \ ' INSPEC OR 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., > 6 U - I 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 state laws relating to building construction, and hereby authorize representatives of this city to enter the. above- mentioned property for inspection purposes. Validated by: r Signature of applicant Date 1, Mailing Address Validation: City, State, Zip - € WHITE - FINANCE, PINK APPLICANT, GREEN BUILDING, GOLDENROD - ASSESSORS OFFICE, HARD COPY FILE ti i - y' az _ F : ... . CONSTRUCTION ESTIMATL NO. ELECTRICAL FEES NO. PLUMBING FEES IIST FL SO FT N $ UNITS COLL. AREA SLAB GRADE / 3 YARD SPKLR SYSTEM 2ND FL SO FT. C HEATING (ROUGH) STORAGE TANK FORMS MOBILEHOME SVC. BAR SINK POR SO FT QY DUCT WORK ROCK STORAGE FOUND. REINF. POWER OUTLET ROOF DRAINS GAR SO. FT. fp HEATING (FINAL) OTHER APP.IEOUIP. REINF. STEEL DRAINAGE PIPING CARP. SO FT. 9 GROUT DRINKING FOUNTAIN WALL SO. FT. rd FINAL INSP. BOND BEAM URINAL SO. FT. a GRADING CU. yd. plus xE =$ ESTIMATED CONSTRUCTION VALUATION $ FINAL INSP. WATER PIPING NOTE: Not to be used as property tax valuation ROOFING C/I y FLOOR DRAIN MECHANICAL FEES REMARKS: WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHERIAUTONDISHI APPLIANCE DRYER GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED^ LAUNDRYTRAY AIR HANDLING UNIT CFM KITCHEN SINK ABSORPTION SYSTEM B.T.U. TEMP USE PERMIT SVC WATER CLOSET COMPRESSOR HP I POLE, TEM/PERM LAVATORY HEATING SYSTEM FORCED GRAVITY AMPERES SERV ENT SHOWER BOILER B.T.U. SO. FT. ® c BATH TUB MESH SO. FT. Ig c WATER HEATER MAX. HEATER OUTPUT, B 1,U. SO. FT. RESID @ tw c SEWAGE DISPOSAL SO.FT.GAR r Vic HOUSE SEWER FINAL INSPECTION GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEE MECH.FEE PL.CK.FEEj CONST. FEE ELECT. FEE SMI FEE PLUMB FEE GARDEN WALL FINAL n STRUCTURE PLUMBING= ELECTRICAL HEATING 8 AIR COND. SOLAR SETBACK GROUND PLUMB -NG —UNDERGROUND A.C. UNIT COLL. AREA SLAB GRADE / 3 ROUG PLUMB ) BONDING HEATING (ROUGH) STORAGE TANK FORMS r ROUGH WIRING DUCT WORK ROCK STORAGE FOUND. REINF. GAS (ROUGH) METER L OP HEATING (FINAL) OTHER APP.IEOUIP. REINF. STEEL GAS (FINAL) V POLE GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM $ GRADING CU. yd. plus xE =$ LUMBER GR. FINAL INSP. FRAMING Z� r FINAL INSP. ROOFING C/I y / //. �/(v REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR - GAR. FIREWALL LATHING. ' 2.1 MESH INSULATION/SOUND L/ FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESlINITIALS GARDEN WALL FINAL