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05413 (SFD)T4ht 4 4 QMk& P.O. BOX 1504 Building-�i�.�� 78-105 CALLE ESTADO Address . LA QUINTA, CALIFORNIA 92253 Owner Mailing Address 42-600 COOK STnn3 SIL 20 `" w CityZip Tel. MIX DF.S. 92260 5.8-2,026'. Contractor NATIONAL HOMAGE Address S ME City lZip Tel.: State Lic. ��3� & Classif. Arch., Engr:, Designer Address No. 05413 UILDING: TYPE CONST. - OCC: GRP. :P: Number egal Description GI BA roject Description YU IE .,pry 208Lic. # Sq. Ft. No. Size 34€1 Stories Tel. City(Zip I State Lic. # LICENSED CONTRACTOR'S DECLARATION 1 hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section ,r 7000) of Division.3 of the Business and Professions Code, and my license i5116 full force and: , effect y _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, after, improve, demolish, or repair any structure, prior to its issuance also requires the applicant for such permit to rile 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 civil penalty of not more than rive hundred dollars (8500). ❑ 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 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 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.) ❑ I, as owner of the property, am exclusively contracting with licensed contractors to con- 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 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 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: ft, after making this Certificate of Exemption youshould become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3697, Civil Code.) Lender's Name Lender's Address 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. 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. Signature of applicant Date Mailing Address City, State, Zip No. Dw. Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ REMARKS ZONE: BY: Minimum Setback Distances: Front Setback from Center Line Rear Setback from Rear Prop. Line Side Street Setback from Center Line Side Setback from Property Line FINAL DATE INSPECTOR Issued by: Estimated Valuation 242..430 PERMIT Validation: AMOUNT Plan Chk. Dep. Plan Chk. Bal. 1�• Const 1, Mech. Electrical Plumbing -50 87 . S.M.I. 17- 01 -Grading Driveway Enc. Infrastructure 4. • $ C rt Lnl:ra Due 2o727.34 TOTAL '` z 7 REMARKS ZONE: BY: Minimum Setback Distances: Front Setback from Center Line Rear Setback from Rear Prop. Line Side Street Setback from Center Line Side Setback from Property Line FINAL DATE INSPECTOR Issued by: Date3/3/89 Permit Validated by: Validation: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES IST FL. SQ. FT. ® $ UNITS A.C. UNIT COLL AREA GRADE YARD SPKLR SYSTEM 2ND FL. SQ. FT. BONDING HEATING (ROUGH) MOBILEHOME SVC. BAR SINK POR. SQ. FT. 0 ROUGH WIRING POWER OUTLET ROOF DRAINS GAR. SO. FT. ® OUGH) METER LOOP DRAINAGE PIPING CAR P. SO. FT. ® REINF. STEEL (FINAL) DRINKING FOUNTAIN. WALL SQ. FT. GROUT WATER HEATE URINAL SQ FT ® FINAL INSP. ESTIMATED CONSTRUCTION VALUATION $ WATER PIPING NOTE: Not to be used as property tax valuation FLOOR DRAIN MECHANICAL FEES LUMBER GR. WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER X/1-IrOOFING 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, TEM/PERM LAVATORY HEATING SYSTEM FORCED GRAVITY AMPERES SERV ENT SHOWER BOILER B.T.U. SQ. FT. ® c BATH TUB SP RK ARRESTOR SQ. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SQ. FT. RESID ® 11/. c SEWAGE DISPOSAL LATHING SQ.FT.GAR ® 3/ac HOUSE SEWER GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEE MECH.FJEEPLCK.FEE CONST. FEE ELECT. FEE SMI FEE PLUMB. FEE STRUCTURE PLUMBING ELECTRICAL HEATING & AIR GOND. SOLAR SETBACK GROUND PLUMBING. UNDERGROUND A.C. UNIT COLL AREA GRADE R U PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMSEWER 0 ROUGH WIRING DUCT WORK ROCK STORAGE FOUND. REINF. OUGH) METER LOOP HEATING (FINAL) OTHER APPJEQUIP. REINF. STEEL (FINAL) TEMP. POLE GROUT WATER HEATE CE �/' FINAL INSP. BOND BEAM WATER SYSTEM GRADING cu. yd. $ plus x$ =$ LUMBER GR. FINAL INSP. MING FINAL INSP. X/1-IrOOFING REMARKS VENTILATION FIRE ZONE ROOFING ' FIREPLACE SP RK ARRESTOR LL LATHING MESH. INSULATION/SOUND S FINI GRADING NAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL t