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04268 (SATT).y,.•� •cam;. ;s r.t-,.• TA O �A26 P.O. BOX 1504 Building 78 -409- rd•er.—ai Cotta .Ct.78-105 CALLE ESTADO '*Address LA QUINTA, CALIFORNIA 92253., Boulevard valopment �- BUILDING: TYPE CONST. OCC. GRP. - Mailing, Address 77.7 ,S. Main Street*,, suite. ,106 , A.P..Number 613 -790 -002 - city 13•^790-002'City Zip Tel. Orange 92686 1714-!-547-8056 Legal Description '!• .e rt F a. 4 In v r r x na t Yr R .. Y -i w ,i • ♦ ,. • Contractor Project Description sz Address PaIM Royale r Plan d ^� Buri Ming .13 - City Zip Tel. ` State Lic. City & Classif. 462814 Lic. # w » ti Sq; Ft. _76 No. No. Dw` Size Stories 4A.Units Arch., Engr., ) Designer, .• + New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Address' Tel. City, 1 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 oFthe Business and Professions Code, and my license is in full force and effect. �GNATURE �� d DATE t' Z i OWNER -BUILDER DECLARATION Estimated Valuation I hereby affirm that I am exempt from the Contractor's License Law for the followingCJ6$ . ' reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a • 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 thathe 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 (5500). Plan , Chk. Bal. r at 9 ♦i ❑ 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. � r Professions' Code: The Contractor's License Law does not 'apply to an owner of property who , VU builds or Improves thereon and who does such work himself or through his own employees, Mech. 3j a uu provided that such improvements are not intended or offered for sale. If, however, the building Iqt ++4 - or improvement is sold within one year of completion, the owner -builder will have the burden , Electrical 7 . 7•^Y V - of proving that he did not build or improve for the purpose of sale.) _ ❑ I, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing (7 city struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License law C does not apply to an owner of property who builds or improves thereon, and who contracts for S.M.I. 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 �•i 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. TOTAL "�►C�lJl�i.ff,:,?�}`k • ti- 1 t v CERTIFICATE OF EXEMPTION FROM REMARKS WORKERS' COMPENSATION INSURANCE (This•sectlon need not be completed if the permit is for one hundred dollars (S 100) , valuafkm - � §1',5 „ {3 i '' ��- Jx (. �• or less.) I certify that in the performance of thip 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 Minimum Setback Distances:' comply with such provisions or this permit shall be deemed revoked. Front Setback from Center Line • Rear Setback from Rear Prop. Line' CONSTRUCTION LENDING AGENCY Side Street Setback from Center Line A 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 FINAL DATE INS7. expiration if work thereunder is suspended for 180 days. r I f / This is a building permit when properly filled out, signed and validated, and is subject to ' { N . y L exp88 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: Signature of applicant Date .. . ,Mailing Address Validation: 4 City, State,, Zip WHITE .FINANCE PINK APPLICANT, GREEN -2 BUILDING, GOLDENROD - ASSESSOR'S OFFICE, HARD COPY - FILE , . t_:ti,. ., .. S+-...` �... ..."S-. •6 •_. -i.,a ... -1�+Fi'?,i, ...0 ... d?S.. i .. \•. f. _.. �-.i�. -. aa.-. 5.'s _ •,��...� se- Y ._.s.K% CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES ISI FL SO F1 N $ UNITS B GRADE �� ROUGH PLUMB BONDING YARD SPKLR SYSTEM 2ND FL SO FT. @ FORMS SEWER OR SEPTIC TANK ROUGH WIRING MOBILEHOME SVC. BAR SINK POR SO FT 0 GAS (ROUGH) METER LOOP HEATING (FINAL) POWER OUTLET ROOF DRAINS GAR SO. FT. Cr TEMP. POLE GROUT DRAINAGE PIPING CAR P. SO FT. 6 FINAL INSP. WALL SO. FT. ¢J WATER SYSTEM DRINKING FOUNTAIN GRADING cu. yd. $---plus—x$—=$ URINAL SO. FT. 0 FINAL INSP. �/ GT MING 3 — `L 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 WASHER(AUTONDISH) APPLIANCE DRYER FIRE ZONE ROOFING GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED FIREPLACE 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 SO. FT. c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID 11A c SEWAGE DISPOSAL SO.FT.GAR 34c HOUSE SEWER FINAL INSPECTION GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEE 1WECH.FEE PL.CK.FEE CONST. FEE ELECT. FEE SMI FEE PLUMB FEE STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR SETBACK UND PLUMBIN Z UNDERGROUND A.C. UNIT COLL. AREA B GRADE �� ROUGH PLUMB BONDING HEATING (ROUGH) STORAGE TANK FORMS SEWER OR SEPTIC TANK ROUGH WIRING DUCT WORK ROCK STORAGE UND. REINF/ /j�U // 1199 vO GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APP.IEOUIP. 00, REINF. STEEL GAS (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM GRADING cu. yd. $---plus—x$—=$ LU BER GR. FINAL INSP. �/ GT MING 3 — `L FINAL INSP. ROOFING REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR - GAR. FIREWALL NG ME NSULATION/SOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS , GARDEN WALL FINAL