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06767 (RPL)aG .f�Qut«ta CityZip P.O. BOX 1504 ." NO. 0676 # Building Address „&hH�1'� 7&105 CALLE ESTADO LA; QUINTA, CALIFORNIA 92253 ' Owner I hereby affirm that I. am licensed under, provisions of Chapter 9 (commencing with'Section; b' " Sunrise pert Paetne" ' ^ ;� is '- !� i .. r �, f 5 , ,/�lV: 'Mailing' _ BUILDING:- TYPE CONST. OCC: GRP ­ Address _ G _Ann r^10$r 02no I hereby affirm that I am exempt from the License Law for the following'�� A.P. Number PGA �I eat -- TrAct 22432-4—Phase 19R _ City Zip Tel: » _ > ' Palm Deaert 568-2828 Legal Description the provisions of the • Contractor's License Law, Chapter .9 (commencing with Section 7000) of Contractor - Division 3 of the Business and Professions Code, or that. he is exempt therefrom, and the basis Project +Description 100 amps elpactrfc mAt�Qr for WAit- -nn vv in TnnA Address - subjects the applicant to a civil penalty of not more than five hundred dollars (5500). Plan Chk. Bal. 4 - O 1,. as owner of the property, or my employees with wages as their sole compensation, will SamI do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and Const. ` Professions Code: The Contractor's LIcense Law does not apply to an owner property who City Zip Tel.: ' Mech. - - • -, ` or improvement is sold within one year of completion, the owner -builder will have the burden ' Electrical �r��� _`p�an� of proving that he did not build of improve for the purpose of sale.) _ State Lic. City Plumbing • struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law N 8L Classif:ai3©. Lic. # . 328 Sq. Ft. Size _ No. No. Dw:. ' Stories _ Units=•� Arch., Engr.; O 1 am exempt under Sec. B. & P.C. for this reason Driveway Enc. Designer Infrastructure - New ❑ Add ❑` Alter -El. Repair ❑ Demolition ❑ Address' Tel. Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.) Policy No. company CityZip State Lic.•# LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I. am licensed under, provisions of Chapter 9 (commencing with'Section; b' 7000) of Division 3 ofttie�rB�fusiness and Professions Code, and`my license is,in full force an8� effect. '� �_ ~�/xs �' �t_� ' ^ ;� is '- !� i .. r �, f 5 , ,/�lV: SGNATURE W ;./ .. ,_ - /DATE " OWNER -BUILDER DECLARATION ?' Contractor's Estimated Valuation'N' � I hereby affirm that I am exempt from the License Law for the following'�� .,reason: (Sec. • 7031.5,Business and Professions Code: Any city or county which requires a permit to construct, atter, improve; demolish, or repair any .structure, prior to its issuance also . requires the applicant for such.permit to Rte 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 that. he is exempt therefrom, and the basis - - - a 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. 4 - O 1,. 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. ` Professions Code: The Contractor's LIcense Law does not apply to an owner property who builds or Improves thereon and who does such work himsel/.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 ' Electrical �r��� _`p�an� of proving that he did not build of improve for the purpose of sale.) _ t94�T00 O 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, such projects with a.contractor(s) licensed pursuant to the Contractor's License Law.) ••, - • Grading l O 1 am exempt under Sec. B. & P.C. for this reason Driveway Enc. i Date owner Infrastructure ' 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.: . ` . c. -. 7 .,.. TOTAL0 ' CERTIFICATE OF EXEMPTION FROM ' s,r5';c.^ :_ a. f t7a. .A m. 'I. Se .L k REMARKS • ,WORKERS' COMPENSATION INSURANCE . (This section need not be completed if the -permit is for one hundred dollars (S 100) valuation - - or less.) - I certify that in the performance of thg 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: 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 ,. comply with such provisions or this permit shall be deemed revoked.' Minimum Setback Distances: - •. .. '{'j ' Front Setback from Center Line Rear Setback from Rear Prop. Line' - CONSTRUCTION LENDING AGENCY Side Street.Setback from Center. Line " 1 hereby affirm that there is a construction lending agency for the performance of the -,work for which this permit is issued. (Sec. 3097, C"Code.) Side Setback from Property Line Lender's • Name ' Lenders Address 'validated, DATE (INSPECTOR This is a building permit when properly filled out, signed and and is'subject to ;FINAL expiration it work thereunder is suspended for 180 days. I certify that 1 have read this 12121-189 application and state that, the above information is correct. I agree Issued by: Date : Permlt 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. . , r - , ' , . Validated by: Signature of applicant 4 Date w rt. Mailing•Address ValldatlOn: City,. State, Zip '' - T CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SO. FT. ® $ UNITS SLAB GRADE ROUGH PLUMB. BONDING YARD SPKLR SYSTEM 2ND FL. Sp. FT. @ FORMS SEWER OR SEPTIC TANK ROUGH WIRING, MOBILEHOME SVC. BAR SINK POR. Sp. Ff. ® GAS (ROUGH) METER LOOP HEATING (FINAL) POWER OUTLET ROOF DRAINS GAR. SO. FT. ® TEMP. POLE GROUT DRAINAGE PIPING CAR P. SO. FT. ® FINAL INSP. WALL SO. FT. WATER SYSTEM DRINKING FOUNTAIN. GRADING cu. yd. $ plus x$ =$ URINAL SOFT ® FINAL INSP. FRAMING 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(AUTO)(DISH) APPLIANCE DRYER 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 ® 1V4 c SEWAGE DISPOSAL SO.FT.GAR ® 3Lc HOUSE SEWER FINAL INSPECTION- 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 APPJEGUIP. 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 G REMARKS: VENTILATION FIRE ZONE ROOFING = FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATION/SOUND FINISH GRADING FINAL INSPECTION- CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL