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04192 (SATT)Building Address Owner Mailing Address City . Contractor Address City ,s2A!'�rdHfc, -A^ s ' P.O. BOX 1504 78-105 CALLE ESTADO 78-4 •� Tiorra Cotta yLA,QUINTA; CALIFORNIA 9,2253, k BUILDING: TYPE CONST. OCC. GRP. 777 S. gain St « , suite 106 A.P. Number 613-790-002 -0022 •. ` 1 Zi ip Tel. . 9248 .-A«597. 2056 Legal Description • Project Description r13t:�,�c' nCr i3. Plan 2 State Lic. & Classif. 462014 Arch., Engr., Designer Zip Tel. City Lic. # r Sq. Ft.. 12 No. No. DW. Size "` Stories Units New ❑ Add,❑ Alter 0 Repair ❑ Demolition O 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, x' effect. SIGNATURE - `-IDATE 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 LEstimated Valuation 065,22S 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 Cade, or that. he is exempt therefrom, and the basis Any Section 7031.5 for Plan Chk. Dep.;ry for the alleged exemption. violation of by any applicant a permit .subjects the applicant to a civil penalty of not more than five hundred dollars ($500). -Plan Chk. Bal. 6+. '� 2 f ❑,I, as owner of the property, or my employees with wages as their sole compensation, will �, q , ;[7.14 , do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and CpnSt.3i y nn q dF7 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. .• +�t� `i�t.t; 0. ' 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 Electrical 44.76 ' 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. 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. _ A .� such projects with a contractor(s) licensed pursuant to the Contractor's.License Law.) • Grading ❑ 1 am exempt under Sec. B. & P.C. for this reason Driveway Enc. Infrastructure I 67 57 Date owner m 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 ?d P2.s !�L• � 1._. ��•�.!.�'# i CERTIFICATE OF EXEMPTION FROM REMARKS S • WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars ($100) valuation [r l�1' _«�9r C A - ,, ct� �' ,T#' ?l;';' 1, 9�.•� f''t'�1K�•'Ss,:.f"`.C� '�° '% io , . - or less.) _ _ ... .. . I certify that in the performance of the 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, alter 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 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.J Side Setback from Property Line ' Lender's Name " Lender's -Address =' FINAL DATE -• INSPECTOR• 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.�� 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 applicantDate ' ' Mailing Address - - Validation: City, State, Zip WHITE FINANCE PINK APPLICANT,.GREEN BUILDING, GOLDENROD - ASSESSORS OFFICE, HARD COPY - "FILE. �' �' �• :,,t _c,.;.'•s ..:. _*' .'r., . ., .- .-� .. �_. •. -.. .t :.d; .,:-:- :: ..,'C.f _.,..fin. c•..•a: .r ;: .. ......t: ro_....-:�:_ . •..Jr. i. :. _a. '",-... _ ,. � •..c �:c�'�..' i •.� � .r�:_ ._ ..-.c.'e"<?r. ;�� CONSTRUCTION ESTIMATL NO. ELECTRICAL FEES NO. PLUMBING FEES IST FL SO Fl rp S UNITS AB GRADE ,Z.� — g ROUGH PLUMB BONDING YARD SPKLR SYSTEM 2ND FL SO FT. 6 FORMS SEWER OR SEPTIC TANK ROUGH WIRING • MOBILEHOME SVC. BAR SINK POR SO Fl. a GAS (ROUGH) METER LOOP HEATING (FINAL) POWER OUTLET I ROOF DRAINS GAR SO. FT. Cl TEMP. POLE GROUT DRAINAGE PIPING CAR P. SO FT. Q FINAL INSP. BOND BEAM WATER SYSTEM DRINKING FOUNTAIN WALL SO. FT. 0 _$ LU ER GR. FINAL INSP. �( NG URINAL SO. FT. (d 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 WASH ER(AUTOKDISH) APPLIANCE DRYER GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED SPARK ARRESTOR LAUNDRYTRAY 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 t+/. c SEWAGE DISPOSAL SO.FT.GAR g lv� c HOUSE SEWER FENCE FINAL ' GAS PIPING PERMIT FEE INSPECTOR'S SIGNATURESIINITIALS 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 ROUND PLUMBING 4,4L> UNDERGROUND A.C. UNIT COLL. AREA AB GRADE ,Z.� — g ROUGH PLUMB BONDING HEATING (ROUGH) STORAGE TANK FORMS SEWER OR SEPTIC TANK ROUGH WIRING • DUCT WORK ROCK STORAGE EINF./� ✓/ �. S C2� / ! �7 GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APP.IEOUIP. REINF. STEEL GAS (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM GRADING cu. yd. $ p1U5 x$ _$ LU ER GR. FINAL INSP. �( NG FINAL INSP. ROOFING REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL ff&AIITN"� MESH 04 LATIONISOUNO r FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL ' INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL