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04153 (MFD5)-------------------- T4'lt 4 4 Qum& di Addrress 78-097 Cobalt Drive Owner P.O. 78-105 CA LA QUINTA, C Mailing Address 777 S. Main St.,, Suite 106 City Zip Tel. Orange 1 92686 714-;547-8056 Contractor S18i:ta Address p j Tel. State Lic.I City & Classif. 46181 Lic. # Designer Address Tel. =I CityI Zip I State 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 my license is in full force and effect. ^.� Nrj:}� i� 2r-:!>hrri_✓ SIGNATURE 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, improve, 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 70001 of Division 3 of the Business and Professions Code, or thathe 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.) O 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 +"�� r t,x r O Copy is filed with the city. 0 Certified copy is herebyPfuinished. 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 thg 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 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 pemlit 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 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 BOX 1504 LLE ESTADO ALIFORNIA 92253. BUILDING: TYPE CONST. OCC. GR \ A P NIInlhpr • .613-790-046 04:x.53 Legal Description Project Description Building 15, Plan 1 REMARKS ZONE: BY: Minimum Setback Distances: Front Setback from Center Line Rear Setback from Rear Prop. Line Side Street Setback from Center Line 11 Side Setback from Property Line FINAL DATEII`1SRPE,CT�OR8 Issued by: Date fit/ I Permit Validated by: Validation: WHITE - FINANCE, PINK - APPLICANT, GREEN - BUILDING, GOLDENROD - ASSESSOR'S OFFICE, HARD COPY - FILE Sq. Ft. 926 Size No. Stories No. Dw. Units New O Add ❑ Alter ❑ Repair O Demolition ❑ Caracre included Estimated Valuation $66t731 PERMIT- AMOUNT Plan Chk. Dep. Plan Chk. Bal. 277.82 Const. 334 0'.00 Mech. 36.00 Electrical 45.04 Plumbing 75.00 S.M.I. 4.66 Grading Driveway Enc. Infrastructure L501.45 wringe-Toea Mara • i TOTAL 32 •r • REMARKS ZONE: BY: Minimum Setback Distances: Front Setback from Center Line Rear Setback from Rear Prop. Line Side Street Setback from Center Line 11 Side Setback from Property Line FINAL DATEII`1SRPE,CT�OR8 Issued by: Date fit/ I Permit Validated by: Validation: WHITE - FINANCE, PINK - APPLICANT, GREEN - BUILDING, GOLDENROD - ASSESSOR'S OFFICE, HARD COPY - FILE CONSTRUCTION ESTIMATL NO. s a, ELECTRICAL FEES NO. PLUMBING FEES IST FL SO FT y COLL. AREA SLAB GRADE -71- Qj 9 ROUGH PLUMB YARD SPKLR SYSTEM 2ND FL SO FT, a STORAGE TANK FORMS MOBILEHOME SVC. BAR SINK POR SO FT. a FOUND, REINF. AS(ROUGH) POWER OUTLET ROOF DRAINS GAR SO. FT. it REINF. STEEL GAS (FINAL) TEMP. POLE DRAINAGE PIPING CAR P. SO FT. GROUT WALL SO. FT. @ - ' - DRINKING FOUNTAIN BOND BEAM URINAL SO. FT. rB GRADING cu. y0. $ —plus—x$ ESTIMATED CONSTRUCTION VALUATION $ LUMBER GR. WATER PIPING NOTE: Not to be used as property tax valuation INAL INSP. _ _ / FLOOR DRAIN MECHANICAL FEES WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTONDISH) APPLIANCE DRYER GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED FIRE ZONE ROOFING�E/ LAUNDRYTRAY AIR HANDLING UNIT CFM FIREPLACE 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 g I% c SEWAGE DISPOSAL SO.FT.GAR !V c HOUSE SEWER - GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEE MECH.FEPLCIFEE CONST. FEE ELECT. FEE SMI FEE PLUMB:FEE - r INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL STRUCTURE PLUMBING ELECTRICAL HEATING 8 AIR GOND. SOLAR SETBACK' GROUND PLU BING v 4 UNDERGROUND A.C. UNIT COLL. AREA SLAB GRADE -71- Qj 9 ROUGH PLUMB BONDING , HEATING (ROUGH) STORAGE TANK FORMS SEWER O SEPTIC TANK ROUGH WIRING DUCT WORK ROCK STORAGE FOUND, REINF. AS(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. y0. $ —plus—x$ ' _ $ LUMBER GR. FINAL INSP. tl '7Vog::�p FRAMING• �� j INAL INSP. _ _ / ROOFING REMARKS: VENTILATION FIRE ZONE ROOFING�E/ FIREPLACE SPARK ARRESTOR! GAR. FIREWALL is LATHING419/w MESH INSULATIONISOUND'Q Gam[ FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL - r INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL i f-