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05968 (SFD)414 a" P.O. BOX 1504 N o . 05968 Building y_5-485 SoUt'ter• yjills 7&105 CALLE ESTADO Address .LA QUINTA,.CALIFORNIA .92253 Sunrise Co. Mailing Address 75--,-005 Country Club Cityp Tel. r_9..60 P*.D* .565-2828 Contractor $ M_ Address Tel." State Lic. I City 4 `Classif. Jnr i �h. Lic. # '4 BUILDING: TYPE CONST. OCC: GRP. A.P. Number.t Legal Description Project Description Plage 17B Plan 3 • Address Tel. City Zip State Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing with Section x1100) effecto .!.,Division 3 of the Business and Professions Code, and my license is in full force and .r SIGNATURE - - DATE OWNEWBUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason: (Sec. 7031.5,8usness and Professions Code: Any city or county which requires a permit to construct, after, improve, demolish, or repair any structure, prior to its issuance also requires the applicant for such permit to Me 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 basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a ch d penally of not more than rive hundred dollars (8500). ❑ 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 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, provided that such improvements are not intended or offered for sale. If, however, the building orimprovement 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.) ❑ I, as owner of the property, am exclusively contracting with licensed contractors to con• struct the project (Sec. 7044, Bushess and Professions Code: The Contractor's License Law does not apply to an owner or property who builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) ❑ 1 am exempt under Sec B. & P.C. for this reason Date owner WORKERS' COMPENSATION DECLARATION 1 hereby affirm that 1 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. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars ($100) valuation or less.) I certify that in the performance of thg work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California Sq. Ft.� No. No. Dw. Size . Stories Units New= Add ❑ Alter ❑ Repair ❑ 'Demolition ❑ . e Owner "NOTICE TO APPLICANT: !f, after mating this Certificate of Exemption youshould become ZONE: BY: subject to the workers' Compensation provisioris or the Labor Code, you must forthwith comply with such Provisions orthis Permit shag be deemed revoked. Minimum Setback Distances: Estimated Valuation 194,692.00 PERMIT Rear Setback from Rear Prop. Line AMOUNT Plan Chk. Dep. Side Street Setback from Center Line I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (sec. 3097, Civil Code.) Plan Chk. Bal. Side Setback from Property Line •�� / Const. 972. Mech. INSPECTOR .: Electrical L . Plumbing . ,$ vit' • UV S.M.I. Date Permit i • Grading construction, and hereby authorize representatives of this city to enter the above. Driveway Enc. mentioned property for inspection purposes. Infrastructure Signature of applicant Date .S. S crect1ir 290,2V Mailing Address Due l City,. State, Zip TOTALittiJ/. REMARKS n�►c art_. r'C1.:1,*. �� 5t'.-._' fl fit e Owner "NOTICE TO APPLICANT: !f, after mating this Certificate of Exemption youshould become ZONE: BY: subject to the workers' Compensation provisioris or the Labor Code, you must forthwith comply with such Provisions orthis Permit shag 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 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.) Side Setback from Property Line Lenders Name Lenders Address FINAL DATE INSPECTOR 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. ISSued'by: Date Permit 1 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: l City,. State, Zip CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES PLUMBING FEES IST FL. SO. FT. ® $ UNITS E COLL. AREA GRADE ` YARD SPKLR SYSTEM 2ND FL S0. FT. ® BONDING HEATING (ROUGH) MOBILEHOME SVC. BAR SINK POR. SO. FT. ® ROUGH WIRING POWER OUTLET DRAINS GAR. SO. FT. ® ///C'VA}, AS (ROUGH) �v/.Y� ( IROOF HEATING (FINAL) DRAINAGE PIPING CARP. SO. FT. ® GAS (FINAL) TEMP. POLE DRINKING FOUNTAIN. WALL SO. FT. GROUT WATER HEATER SERVICE URINAL S0. FT. BOND BEAM ESTIMATED CONSTRUCTION VALUATION $ WATER PIPING NOTE: Not to be used as property tax valuation GRADING Cu. yd. —Plus—X$—=$ FLOOR DRAIN MECHANICAL FEES WATER SOFTENER VENT SYSTEM FAN EVAP.000L HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER v O �A GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED REMARKS: LAUNDRYTRAY AIR HANDLING UNIT CFM 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 r SO. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 1+/. c SEWAGE DISPOSAL SO.FT.GAR ® V4c HOUSE SEWER MESH 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 SETBACKOUND PLUMBING UNDERGROUND A.C. UNIT COLL. AREA GRADE ` ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMS WER OR S ROUGH WIRING DUCT WORK ROCK STORAGE UND: F. ///C'VA}, AS (ROUGH) �v/.Y� ( METER LOOP HEATING (FINAL) OTHER APPJEOUIP. EINF. ST GAS (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM $ GRADING Cu. yd. —Plus—X$—=$ LUMBER GR. 4 NAL INSP. r— / F ING /Z-227201FINAL INSP. FING v O �A �� I �. I - �i/f �G REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIRE/WALL LATHING MESH INSULATION/SOUND .,.,'2 FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL