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14718 (AR)44 P.O. BOX 1504 N 0. 7 • Building %g"69F1.T ,'fib�1£'rT 78-495 CALLE TAMPICO LA OUINTA, CALIFORNIA 92253 18 Address ':. Owner Betty. Kasgel ®ff BUILDING: TYPE CONST. " OCC: GRP:. .Mailing r$r y. At .' i� -�° Same Address A.P. Number • City Zip Tel. Pa1m Desert, 'C.1. 9221.1 c-74 77.3 Legal Description ContractorPlAn . 8 Sonus Room. ject Description ..Address . WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND /-J ' SHALL SUBJECT AN EMPLOYER - TO CRIMINAL PENALTIES AND CIVIL FINES UP. TO ONE CityZip ' HUNDRED THOUSAND, DOLLARS ($100,000), IN ADDITION TO -THE COST OF COMPENSATION; DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THELABOR CODE, INTEREST,"AND •�-.I Tel-: ATTORNEY'S FEES. State Lic. F 48-8234 & Classif.. City i85a Lic. # Sq. Ft. 224 Size No. No. Dw. -.Stories Units Arch.,-Engr.; . Designer New Ov Add O . , 'Alter O - Repair ❑ - ..-Demolition, 0' , Address Tel. _ x �•' Valldat4 y: Signature of applicant Date City Zip State Lic. # City, State, Zip = {� f�. .✓y r �� LICENSED.CONTRACTOR'SDECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section . 7000) of Divviision,3 offefhe Bussindbs aan�d•Professsiio"nnsfCode, rid my license is:in full force and • . effect. Ile. .d 1 ; �i✓t'jtrfs SIGNATURE 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 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 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 bast for the alleged. exemption: Any violation of Section 7031.5 by 'any applicant for a..permit - " subjects the applicant to a civil penalty of not more than rive hundred dollars (5500). .O. 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 .0-9.00 . Professions Coder 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. 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 of proving that. he did not build or improve for the purpose of sale.) O'l, as owner of the property, am exclusively contracting with licensed contractors to con, • struct the project. (Sec: 7044, Business and Professions, Coder The, Contractor's License -Law does not apply to an owner of propertywhobuilds or improves thereon, and who contracts for • such projects with'a contractors) licensed pursuant to the Contractor's License Law.) , ❑ I am exempt under Sec > B. & P.C. for this reason Estimated Valuation e�gg f 9 A q `P a F.J sd i • ©�. PERMIT. - AMOUNT Plan Chk. Dep. Plan Chk. Bal. >� 3J -' COr1St. A 9g . 90 �, {� Q 5 • Electrical . ff d . Q _ G 8 . Plumbing S:M.I. - .71 Grading Driveway Enc. Date Owner Infrastructure WORKERS' COMPENSATION DECLARATION I hereby affirm that 1 have a. certificate of consent to self -insure, "or a certificate of - Workers mpensation Insurance, or a certified copy thereof. (Sec. 3800; Labor Code.) " Policy Not Company !.�eopy is filed with the city,- . ❑ Certified copy -is hereby furnished. - CERTIFICATE OF EXEMPTION FROM 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 thq work for which this permit is issued, I shall not ' 'employ any pperson in any manner so as to become subject to the Workers' Compensation •• Laws of California Date Owner NOTICE TO APPLICANT: d, after making this Certificate of Exemption 'you should. become subiect' to the Workers' Compensation provisions, of the Labor Code, you must forthwith .• comply with such provisions or this permit shall be deemed revoked... .' TOTAL 201.90 REMARKS - ZONE:: � •BY:" Minimum Setback Distances:, - c WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND /-J ' SHALL SUBJECT AN EMPLOYER - TO CRIMINAL PENALTIES AND CIVIL FINES UP. TO ONE ' HUNDRED THOUSAND, DOLLARS ($100,000), IN ADDITION TO -THE COST OF COMPENSATION; DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THELABOR CODE, INTEREST,"AND •�-.I _ _' . n'n r t3' IJJ.1 ATTORNEY'S FEES. FINAL DATE This is a building permit when properly filled out, signed and validated, and is'subject to 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: • . r Issued by: 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. �•' Valldat4 y: Signature of applicant Date Mailing Address Validation: City, State, Zip = {� f�. .✓y r �� )nt Setback from Center Line ar, Setback from Rear Prop. Line IeiStreet Setback frorn'Center Line leSetbackfrom Property. Line INSPECTOR -�' • Date Permit CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBIW FEES 1ST FL. SO. FT. ® $ UNITS COLL. AREA SLAB GRADE ' YARD SPKLR SYSTEM 2ND FL. SO. FT. ® HEATING (ROUGH) STORAGE TANK FORMS MOBILEHOME SVC. BAR SINK POR. SO. FT. ® DUCT WORK ROCK STORAGE GAR. SO. FT. ® POWER OUTLET ROOF DRAINS METER LOOP HEATING (FINAL) DRAINAGE PIPING CAR P. SO. FT. GAS (FINAL) WALL SD. FT. DRINKING FOUNTAIN SO. FT. ® URINAL ESTIMATED CONSTRUCTION VALUATION $ FINAL INSP. WATER PIPING NOTE: Not to be used as property tax valuation FLOOR DRAIN MECHANICAL FEES GRADING -cu. yd. $ plus x$ WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER FINAL INSP. GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED LAUNDRY TRAY 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 ® 1 Va c SEWAGE DISPOSAL SO.FT.GAR ® 3/ic 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 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 APP.IEOUIP. 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 REMARKS: VENTILATION FIRE ZONE ROOFING ' FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING�\ MESH INSULATION/SOUND FINISH GRADING FINAL INSPECTION I CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL