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003314 (PAT)' P.O. BOX 1504 NO. ��'��� � ' ' Building 78-105 CALLE ESTADO , Address' ������ �'l•u��� '$�i4ts°'� LA QUINTA, CALIFORNIA 92253 .41'4ib/ 3.y4iW •Mailing . _ . Address $tom City Zip - Contractor Address Tel. ..������ BUILDINGr TYPE CONST. � OCC: GRP. A.P. Number Legal Description ,. Project Description g� �;�� �'�--�-� „ ��`��� ���• . - - -. .City Zi.p Tel.. .. .. .. , State Lic. City & Classif.• Lic: # Sq. Ft. � - Size- 2�tt • No. � No. Dw. Stories • •�. - : - Units ' •Arch:; Engr., ..._ .... ._.. .Designer � '� - .. •New ❑ Add+>~!s Alter ❑ •.Repair ❑' Demolition ❑. . 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 Division3 of the Business and Professions Code, and my license is in full force and' .effect. .. � .,. _SIGNATURE DATE ' OWNER•BUILDERDECLARATION - ` I hereby affirmthat I am exempt from the Contractor's License Law for the following reason: (Sec. 7031.S,Business and.Prolessions Code: Any city, or county, which requires a; EStlmated VdlUatlOn. � I� 4'iw��� :, •. -' +�L - � � - � PERMIT - � .� � .. � - AMOUNT � • - � � �r �• permR io construct: alter, improve, demolish, or repair any structure, prior �to its issuance also a .,.requires the applicant for such permit fo file a signed statement that he is licensed pursuant to the provisions of the Contractor's;�Llcense Law, Chapter. 9 (commencing with Section 7000) o/ ' Division 3 0/ the Business and Piolessibns •Cdde, o/ thaChe is'exempt `lherelrom, and�the basis for the alleged exemption. Any violation o/ Section -2031.5 Dy 'any applicant for a permit. - ' � subjects the applicant to' a civil penalty o/not more than live hundred dollars ($500). � � � ' ` � ': ❑ I, as owner of the property, or my emplgyees with wages,as_ their sole compensation, will do the work, antl the structure is not intended oroffered for sale..(Sec. 7044',.Buisness and .. Pro/essions: Code:, The. Contractor's License Law does.not��apply to an owner of property, who. ��who - � � .PIan:Chk: Dep:� � - - .+ - � - - � . � Flan. Chk. Bal... - . � - ���¢��. COnSt.' � � �� ����� , ' Mech. ` ' ' � � ' builds or improves thereon and does such woik himsel! or through his own employees, .provided that such improvements are not intended or ollered tor, sale. 11„however, the building • or improvement is'sold within one year of completion, •the owner -builder will have the burden o/proving that he did not build or improve for the purpose o/sale.) •, � � Electrical � � � - � ` '” ' Plumbing � ` ❑ I,.as owner of the property, am exclusively contracting with licensed contractors to con- strucl the project. (Set. 7044,. Business and Professions• Coder The Confreclor's'License Law • does not apply to an owner o/ property who builds or improves thereon, and who contracts for -such pro%ects�with a contractor(sylicensed pursuant to the Contractor's License Law:) •• f7 I am.exempt under. Sec. B. 8 P.C. for this reason ' ' •. S',M.L' � G�1 - � � - e,.ts - . _ Grading - Driveway Enc. Date �`����-� owner -� ? Infrastructure WORKERS' COMPENSATION DECLARATION .. , • :' I hereby affirm that'1 have a certificate of consent .to. self -insure, of 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 .. >rjf��� _ REMARKS - - ' _ - CERTIFICATE OF EXEMPTION FROM . .. ,. WORKERS' COMPENSATION INSURANCE .' - . • .. - . (This section need not be completed iI the permit is Ior one hundred dollars ($100) 'valuation orless.) ... .. .. .. .. ... .. _ I certify that in the performance of thg work for which this permit is issued, I sFiall not employ ahy persory in any manner so as to become subject to the Workers'•Compensation Laws of California. � _ . .' , .., .,,,�,. ;, ,'.: ,�,-t ' , r1 ,,,; � �,;,�, . a W ,,,,: .,;, �4/ � qq �� y' �• � tI'3 ' Date'' 'Owner" ` .NOTICE TO. APPLICANT: ll, ager making this Certi/icate oI Exemption you should become' ' 'sub%ect-'to the 'Workers' Compensation provisions o/ the Labor coda; you must Iorrnwuh � comply with such provisions or this permit shall be deemed revoked. � � � � � ZONE: � - BY: ' � �� •Minimum Setback Distances: - - - � � � � - • Front Setback from Center Line ' ,Rear Setback from Rear Frop. Line CONSTRUCTION LENDING AGENCY � 1 hereby affirm that there fs a construction lending agency:forthe performance.of the �. work for which this permit is issued. (Sec: 3097, Civil Code.) Side Stfeet Setback from CeMer'Llne' ' Side Setback from.Property Llne ' Lender's Name ' Lender's,Address � FINAL.DATE Issued by: � � � � - - VBlldated by: INSPECTOR ' .• .. � � .., Date � � � � ��1 -Permit �- - � - � .. � r'` - ,- 'This is'a building permit when properly filled out, signed and validated; and.is'subject tD'' expiration -if work thereunder is suspended for 180 days. -. I certify that I have read this application and state that. the above information is •correct. ''' 1 agree to comply with all oity�and county ordiriances�and state laws relating to building consWction, and hereby authorize representatives' sof this city to � enter the above-. � ' mentioned property for inspection purposes. � , Signature of applicant Date - Mailing Address _ V811datlOn:. - ' City, 'State, Zip �r ._. . ' - HARD COPY CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES . 1ST FL. SO. FT. ® $ 2ND FL. SO. FT. POR. SO. FT. ® GAR. SQ. FT. ® CARP. SQ. FT. WALL SO. FT. SO. FT. ® ESTIMATED CONSTRUCTION VALUATION $ UNITS MOBILEHOME SVC. POWER OUTLET YARD SPKLR SYSTEM BAR SINK ROOF DRAINS DRAINAGE PIPING DRINKING FOUNTAIN URINAL WATER PIPING NOTE: Not,to be used as property tax valuation BONDING FLOOR DRAIN MECHANICAL FEES FORMS WATER SOFTENER VENT SYSTEM FAN EVAP.000L HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER GAS (ROUGH) GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED OTHER APPJEOUIP. LAUNDRYTRAY AIR HANDLING UNIT CFM TEMP. POLE KITCHEN SINK ABSORPTION SYSTEM. B.T.U. TEMP USE PERMIT SVC WATER CLOSET' COMPRESSOR HP POLE, TEM/PERM 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 ® 1+/a c SEWAGE DISPOSAL O � f SQ.FT.GAR ® 3/ac HOUSE SEWER REMARKS: 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 & AIR COND. SOLAR SETBACK GROUND PLUMBING UNDERGROUND A.C. UNIT COLL, AREA SLAB GRADE ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMS SEWER OR SEPTIC TANK ROUGH WIRING DUCT WORK ROCK STORAGE FOUND. REINF. GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APPJEOUIP. REINF. STEEL GAS (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM GRADING CU. yd. $ plus x$ =$ LUMBER GR. FINAL INSP. FRAMING FINAL INSP. ROOFING O � f • REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATION/SOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE -FINAL INSPECTOR'S SIGNATURES/INITIALS• GARDEN WALL FINAL ALL, POST. _ . TO 'AiNge (o mo POST It a CITY OF' LA INTA _�Cor�r ' Unifi Develop ► Ed -- _ - g. Dept:-- _ .)?zTI AAM �a E�'" ..: gUAfE{`If Y �� o Two % X 7 BOLTS t3:�d5T;4•�SFR. All. POST To E C - C U� AND pit ()©� 2S HAV MP ®AT i Y� G rN cONLQtT� ',� , ' T :�, . 7R- Z95 N . guar scT R=p6E. • .. , ?AIMS