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10789 (PLBG)U 4 P.O. BOX 1504 No. 10789 Building 53-330 Ave Vallejo 78105 CALLE ESTADO Address LA QUINTA, CALIFORNIA 92253 Owner Mr/Mrs L@BlAlQ Doty (tenant -s) BUILDING: TYPE CONST. OCC: GRP. Mailing Address saln4 A.P. Number 774-083-005 City Zip Tel. La Quinta 92253. Legal Description Contractor Project Description L. L. Wilson Construction Sever Hook Up Address P. O. Box 3687 City 17i Tel.: Indio W2201 342-2322 State Lic. City & Classif. 529319 Lic. # Sq. Ft. No. No. Dw. Arch., Engr., Size Stories Units Designer New 0 Add ❑ Alter ❑ Repair ❑ Demolition D Address Tel. City Zlp State Lic. # UCEMSED CONTRACTOWS DECLARATION 1 hereby affirm that I am I-ucensed uI1dLY provisions of Chapter 9 (commencing with Section effect of tlrtston 3 of to Bosirhess and Pro�essio/ns Code, and my license is in full force and effect 'r 1.4 !- SIGNATURE r - ' DATE ' OWNER-BUILDER°DECLARATIO N I hereby affirm Mat 1 am exempt from the Contractors License Law for the following Estimated Valuation V reason: (Sec- 7031-5.iusbhess and Professiam Code: Any city or county which requires a ) ©0 pemat to construct. ate, &Wave, demolish. or repair any structure, prior to its issuance also requoes the appicard for such pearif to file a signed statement that he is licensed pursuant to - PERMIT AMOUNT the provisions of the moor's License Law, Chapter 9 (commencing with 'Section 7000) of Division 3 of the 0>saeess and PYWessiors Code, or that. he is exempt therefrom, and the basis for the aeged exemption. Any viatatm of Section 7031.5 by 'any applicant for a pema Plan Chk. Dep. subjects the agpirart to a cim7pewilly of not more than rive hundred dollars ($500). plan Chk Bal. ❑ 1, as owner of the property, army employees with wages as their sole compensation, will do the wodr, and the structure is not intended or offered for sale. (Sec. 7044, &rine= and Const. il"Wessiors Code.- 7be Contras Liornse Law does not apply to an owner of property who burrito or irpmves thereon and who does such work himself or through his own evrployees. provided that'such iquovements are not.idended or offered for sale. If, however, the building Meth. or irprovemerd is said wMA acre year of compteDon, the owner -builder will have the burden Electrical of provig tlhat he did not brit or irprove for the purpose of sale.) ❑ I. as owner of the property, am exdusivey contracting with licensed contractors to tort Plumbing struct the project (Sec 7044, �hsihess and Professions Code: The Contractor's License -Law does not apply to an owner of property who builds or approves thereon, and who contracts for S.M.I. such projects with a conbacWs) foasedprnsad to the Contractor's License Law.) Grading ❑ 1 am exempt under Sec -------& & P.C- for -this reason Driveway Enc. Date owner Infrastructure WORKERS! COMPENSATION DECLARATION 1 hereby'affirm that 1 have a certificate of consent to self -insure, or a certificate of Wodwes Compensation Insurance, ora certified copy thereof. (Sec. 3800, Labor Code.) . Policy No Company ❑ Copy is.filed with the city-. ❑ Certified copy is hereby furnished. TOTAL 30.00 COMFWA11E OF EI(EMPTION FROM REMARKS WORIE7IS' COMPENSATION INSURANCE (This section need not be eorrpreted ff the permit is for one hundred dollars ($100) valuation -1..►ti', . t z:xr, orless ) I certify that in the pertomhanoe of the work for which this permit is issued, I shall not =any. person in any manner so as to become subject to the Workers' Compensation Laws of Califomia- Date Owner NOTICE TO APPLICAIvr: q after mam this Certificate of Exemption you s_houkt become ZONE- BY: subject to Me Mkrvkers''Corrpensation provisions' of the Labor Code, you must forthwith corrpty with such Provisions or this permit stsaa 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. ChdCode.) Side Setback from Property Line Le ndees Name Ips Adaress FINAL DATE INSPECTOR This is a building permit whetn property'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 ateMailing Add rrns Validation: City, State, .Tip CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SO. FT. ® $ UNITS SLAB GRADE 2ND FL SO. FT. ®' BONDING YARD SPKLR SYSTEM FOR. SQ. FT. ® MOBILEHOME SVC. BAR SINK GAR. SQ. FT. ® POWER OUTLET ROOF DRAINS CAR P. SQ. FT. ® GAS (ROUGH) DRAINAGE PIPING WALL SQ. FT. OTHER APPJEQUIP. DRINKING FOUNTAIN. SQ FT ® TEMP. POLE URINAL ESTIMATED CONSTRUCTION VALUATION $ GROUT WATER PIPING NOTE: Not to be used as property tax valuation FINAL INSP. FLOOR DRAIN MECHANICAL FEES WATER SYSTEM WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER FINAL INSP. GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED LAUNDRYTRAY 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. SQ. FT. ®c BATH TUB SQ. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SQ. FT. RESID ® 11/4 c SEWAGE DISPOSAL GAR. FIREWALL SQ.FT.GAR ® VLc HOUSE SEWER LATHING GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEE MECH.FEE PLCK.FEE 7NST. 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 EWER'0R1JE Ff&`1* COUGH WIRING. DUCTWORK ROCKSTORAGE FOUND. REINF. GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APPJEQUIP. 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 INSULATIONISOUND FINISH GRADING FINAL INSPECTION - CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINn1ALS GARDEN WALL FINAL