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08107 (SFD)0 P.O. BOX 1504 N o . Building 78-105 CALLE ESTADO Address 54400 Valle,% LA QUINTA, CALIFORNIA 92253 Owner ✓ Mailing Address Same City Zip Tel. Le Quinta 92253 Contractor ress State Lic. City & Classif. Lic. # Arch., Engr., Designer Address Tel. City( Zip ( State I Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that.I am licensed under provisions -of -Chapter 9(commencing with Section 7000) of Division 3 of the Business and Professions Code, and millicense is in full force and effect. .-SIGNATURE ATE OWNER -BUILDER DECLARATION I hereby affirm that I am' exempt from the Contractor's License Law for the following reason.,; (Sec. 7031.5,Business and Professions Code: Any city or county which requires a permft-vo;construct, alter, improve, demolish, or repair any structure, prior to its issuance also requirest4he applicant for such permit to file a signed statement that he is licensed pursuant to the,' ro'visions.of the Contractor's License Law, Chapter 9 (commencing with Section 7000) -of DivisI.,. 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 five hundred dollars ($500). I ❑ 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 or improvement is sold within one year or completion, the owner -builder -will have the burden or 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.) O 1 am exempt under Sec. B. & P.C. for this reason Date Owner 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 0 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. If, after making this Certificate of Exemption you should 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. 3097, 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 it 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 0810 BUILDING: TYPE CONST. OCC: GRP. A.P. Number . . 774-232-06 Legal Description Lot 19 Project Description - Sinde Fami1Y Awelltne ZONE:BY:,�` R•}",.� < .� to Minimum Setback Distances; -.17- Front Setback from Center Line Rear Setback from Rear Prop. Line -Side Street Setback from Center Line Side Setback from Property Line FINAL DATEINSPECTeeOnnR Issued by: Date 6/15/ ""Permit Validated by: Validation: t" r Sq. Ft. Ir `1 Size No. Stories No. Dw. Units New ❑qq ✓'Add ❑ Alter ❑ Repair ❑ Demolition ❑ !T Estimated Valuation �Q r, PERMIT -"AMOUNT AMOUNT Plan Chk. Dep. Plan Chk. Bal. a Const. Mech. j5 Electrical Plumbing S.M.I Grading a On Driveway Enc. - Infrastructure L ", _ A TOTAL !« REMARKS " y ZONE:BY:,�` R•}",.� < .� to Minimum Setback Distances; -.17- Front Setback from Center Line Rear Setback from Rear Prop. Line -Side Street Setback from Center Line Side Setback from Property Line FINAL DATEINSPECTeeOnnR Issued by: Date 6/15/ ""Permit Validated by: Validation: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES IST FL. SO. FT. ® $ UNITS SLAB GRADE rJ �� Q 2ND FL. SO. FT. BONDING YARD SPKLR SYSTEM FOR. SO. FT. ® MOBILEHOME SVC. BAR SINK GAR. SO. FT. ® POWER OUTLET ROOF DRAINS CAR P. i SO. FT. GAS (ROUGH) DRAINAGE PIPING WALL SO. FT. OTHER APPJEOUIP. DRINKING FOUNTAIN. SO 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.000L HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER FRAMING 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. SO. FT. ® c BATH TUB SO. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 11/4 c SEWAGE DISPOSAL LATHING" SO.FT.GAR ® 3/ac 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 GOND. SOLAR' SETBACK /Q It&, OWROUND PLUMBING 7 9 UNDERGROUND A.C. UNIT COLL. AREA SLAB GRADE rJ �� Q 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 APPJEOUIP. REINF. STEEL GAS (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM FINAL INSP. —�3 -11 GRADING cu. yd. $ plus x$ _$ LUMBER GR. FRAMING FINAL INSP. ROOFING / REMARKS: VENTILATION FIRE ZONE ROOFING: FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING" MESH INSULATION/SOUND 7 FINISH GRADING FINAL INSPECTION �7— CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURES11NITIALS GARDEN WALL FINAL Desert Sands Unified School District , CERTIFICATION OF PAYMENT OF C) • SCHOOL. &1ACL' FEES CD1 AIDOCO mor TO:: O: `G� DATE: 140T Mrn�-D� This is to certi thaA developer of which is located at — O within this District, has paid school faci ty fees imposed purs ant to the autho it generated b Glgvprnmenntt Code Se trio ABO in he a oun,t of �/ 101 rim covering a total or l square ' et of ( ) resident1 or W ( ) industrial/commercial development and that building permits for this footage in this development may now be issued by your jurisdiction. !%111" D for DESERT SAND UNIFIED SCHOOL DISTRICT White - Building Department • Yellow - Facilities Planning • Pink - Accounting • Gold - Developer (10)-37 • Buena Engineers, Inc. 79-811 B Country Club Drive Bermuda Dunes, CA 92201 - (619) 345-1588 Client Name Client Address Client Phone FAIL DATE 7 OB NO. i PROJECT LOCATION CONTRACTOR -'OWNER WEATHER TEMP. 0 at AM 0 at PM PRESENT AhSITE DRY : DENSITY lbs./Cu. ft. MAXIMUM DRY DENSITY % TEST NUMBER TEST LOCATION LOT NO. ELEVATION FIELD TESTING REFERENCE CURVE MOISTURE 'CONTENT % DRY : DENSITY lbs./Cu. ft. MAXIMUM DRY DENSITY % MAXIMUM DRY DENSITY lbs./cu. ft. OPTIMUM MOISTURE CONTENT % , <0 Al -07 F/ V n REMARKS: 1 :EE vQ 7-7/ CA 4 r./ 7— /2 er Ac- 4-10 le, ,0[fiENT REPRESENTATIVE SIGNATURE FEEIT.."D REPORT TECHNICIANS SIGNATURE 4676