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04148 (MFD5)tr - 04148 P.O. BOX 1504 Building^ 78"'04 �f�lL1 Drive78-105 CALLE ESTADO Address LA QUINTA, CALIFORNIA 92253 Owner BC#i2lavard Development Address 777 S. Satin Street,, Sul tai JQ,6 _ -, City Zip Tel. Orange 92686 714w547-8056 Contractor Sam Address Zip State Lic.City �� & Classif. Lic. # Arch., Engr., Designer Address Tel. City Zip (State Lic. # JILDING: -TYPE CONST. OCC. GRP. P. Number 613-790-008 egal Description roject Description Buil4 ina 19.• Pl^n i ... , Sq. Ft.. 161, No. No. Dw. Y ^ Size Stories Units LICENSED CONTRACTOR'S DECLARATION I herebyy affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Divislon 3 of the Business and Professions Code, and my license is in full force and effect. t...y .`")'%�-�.�1 SIGNATURE X DATE 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 permit to construct, alter, Imprgve, demolish, or repair any structure, prior to its Issuance also requires the applicant for such permit to file 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 five hundred dollars ($500). O 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 of completion, the owner -builder will have the burden of proving that he did not build or improve for the purpose of sale.) ❑ 1, 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. 8 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 ❑ 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 lhp 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 New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Garage LnClUded Estimated Valuation ♦ 7 PERMIT AMOUNT Plan Chk.- Dep. Plan Chk. Bal. ` 44 � 471 . U 2 Const. 334.00 Mech. 1�(j Electrical ,45.04 Plumbing 75.00 S.M.I. 4.66 Grading Driveway Enc. Infrastructure 11 301.45 TOTAL yr•�.1 i�•t' REMARKS :l*b,'•.r:1QtI4tV Jt:11.44?0tL` i.- -C^:PA e'.. 1.0 s .) 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 DATEIINSPPECT8OR Issued by: Date Permit Validated by: Validation: L ; WHITE - FINANCE, PINK - APPLICANT, GREEN - BUILDING, GOLDENf10D • 455E6SOR'S OFFICE, HARD COPY - FILE CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES ISI FL SO Fl i(a $ UNITS SLAB GRADEGH 50e PLUMB BONDING YARD SPKLR SYSTEM 2ND FL SO FT. C FORMS SEWER OR SEPTIC TANK ROUGH WIRING MOBILEHOME SVC. BAR SINK POR SO FT Cr (ROUGH) METER LOOP HEATING (FINAL) POWER OUTLET ROOF DRAINS GAR SO. FT. iK GROUT DRAINAGE PIPING CAR P. I SO FT. (U FINAL INSP. WALL SO. FT. @ WATER SYSTEM DRINKING FOUNTAIN GRADING cu. yd. plus x$ c $ LUMBER GR. URINAL SO. FT. Q FINAL INSP. ROOFING 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 WASH ER(AUT0)(DISHI APPLIANCE DRYER . GAR. FIREWALL 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. SO. FT. ® c BATH TUB GARDEN WALL FINAL SO. FT. @ c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID g t w c SEWAGE DISPOSAL SO.FT.GAR @ JV c HOUSE SEWER 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 Of GROUND PLUMBING UNDERGROUND A.C. UNIT COLL. AREA SLAB GRADEGH 50e PLUMB BONDING HEATING (ROUGH) STORAGE TANK FORMS SEWER OR SEPTIC TANK ROUGH WIRING DUCTWORK ROCK STORAGE FOUND. REINF. �/ / CT� v v (ROUGH) METER LOOP HEATING (FINAL) OTHER APP.IEOUIP. REINF. STEEL GAS (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM $ GRADING cu. yd. plus x$ c $ LUMBER GR. FINAL INSP. CZ ® FRAMING FINAL INSP. ROOFING �v '/ � �79qq / D�� l r7��2�f•" / } ey ! A n� C REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR, GAR. FIREWALL LATHING ✓%IW �� % MESH INSULATIONISOUND' O v' FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL