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04178 (GRES)P.O. BOX 1504 Building 711,-343 78-105 CALLE ESTADO ' Address -�� • LA QUINTA, CALIFORNIA 92253 M Owner nQt3lovard •ft'Valop tont _4 BUILDING: TYPE CONST. OCC. GRP. Address 777 w City Orange Contractor Zip. Tel. -- 92606 1 1 714-A47.8056 Tel. State Lic.I City & Classif. 4.62.8 14 Lic. # Arch., Engr., Designer Address' Tel. City Zip State • Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I 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., :'" o !r d r SIGNATURE - DATE OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractors License Law for the following reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a A.P. Number 6-13-790-001 Legal Description Project Description 3txi.:tci.;�ag r Plan 2 Sq. Ft., Size New ❑ No. Stories No. Dw. Units Add ❑ Alter ❑ Repair ❑ Demolition'❑ nation $65 * 225 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 - PERMIT .. AMOUNT 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 Any Section 7031.5 by for Plan Chk. Dep. ' alleged exemption. violation of any applicant a permit ' subjects the applicant fo a civil penalty of not more than five hundred dollars ($500). Plan Chk. Bal:3 . l� ❑ 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 Const. Professions Code: The Contractor's License Law does not apply to an owner of property who builds of improves thereon and who does such ,work himself or through his own employees. Mech. J b ' provided that such Improvements are not intended or offered for sale. If, however, the building out) or improvement is sold within one year of completion, the owner -builder. will have the burden Electrical 'f� 0 of proving that he did not build or improve for the purpose of sale.) y. D I, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing -yy� F3 (i 15 • V ii 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 " S.M.I. ` - 4 b !Jk'- such'projects with a contractor(s) licensed pursuant to the Contractor's License Law.) Grading ❑ I am exempt under Sec. B. & P.C. for this reason Driveway Enc. Date Owner Infrastructure A. Lzalxui 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. I Company O Copy is filed with the city. ❑ Certified copy is hereby furnished. TOTALfF CERTIFICATE OF EXEMPTION FROM REMARKS " 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 Owner • NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become ,. • ZONE: BY: - subject 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 Rear 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 • Lender's Address ' • _ This is a building permit when properly filled out, signed and validated, and is subject to FINAL DATE • v INISPECfTO�Ry expiration it work thereunder is suspended for 180 days. / ! T✓ I certify that I have read this application and stale that the above information incorrect. 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: -Signature of applicant Date ' Mailing Address Validation: - • City, State, Zip ^ WHITE - FINANCE, PINK APPLICANT, GREEN - BUILDING, GOLDENROD - ASSESSOR'S OFFICE, HARD COPY - FILE - ,.4 1..::'�I .�,_-...a.; ... -.:,.s _-- A:..."s;. .., -.; ._ . -,., .n �_ .._+h,: r,,..�C...:.... w_ __ ......_�.. .. ._ .. _• ,._..a. .,. -_. -..._ � -_•♦ 9... , v -'a •_ „r <.° i CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES $ UNITS LAB GRADE �?j ISI FL SO FT y BONDING HEATING (ROUGH) STORAGE TANK FORMS YARD SPKLR SYSTEM 2ND FL SO FT. @ DUCT WORK ROCK STORAGE ✓ OUND. REINF` �— MOBILEHOME SVC. BAR SINK POR SO FT. @ OTHER APP.IEOUIF. REINF. STEEL GAS (FINAL) POWER OUTLET ROOF DRAINS GAR SO. FT. @ GROUT WATER HEATER SERVICE FINAL INSP. DRAINAGE PIPING CAR P. SO FT. @ WATER SYSTEM GRADING cu. yd. b plus x$ _$ DRINKING FOUNTAIN WALL SO. FT. @ FINAL INSP. AMING �/ FINAL INSP. URINAL SO. FT. @ REMARKS: ESTIMATED CONSTRUCTION VALUATION $ WATER PIPING NOTE: Not to be used as property tax valuation FLOOR DRAIN MECHANICAL FEES WATER SOFTENER VENT SYSTEM FAN EVARCOOL HOOD SIGN WASHER(AUTOXDISH) 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 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 @ I% c SEWAGE DISPOSAL CERT. OCC. SO.FT.GAR @ 3/ac 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 ,y ELECTRICAL HEATING 8 AIR COND. SOLAR SETBACK GROUND PLUMBI .Q7 UNDERGROUND A.C. UNIT COLL. AREA LAB GRADE �?j ROUGH PLUMB BONDING HEATING (ROUGH) STORAGE TANK FORMS SEWER OR SEPTIC TANK ROUGH WIRING DUCT WORK ROCK STORAGE ✓ OUND. REINF` �— GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APP.IEOUIF. REINF. STEEL GAS (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM GRADING cu. yd. b plus x$ _$ LUMBER GR. FINAL INSP. AMING �/ FINAL INSP. OFING REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SP RK ARRESTOR IREW L01 LATHING MESH IONISOUND2---/5--'r FINISH GRADING FINAL INSPECTION [[[ CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATU'4ESlINITIALS GARDEN WALL FINAL