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04281 (MFD5)4 P.O. BOX 1504 Building 78-105 CALLE ESTADO Address 78-107 Cobvilt Drive LA QUINTA, CALIFORNIA 92253 Owner a4Gc . Mailing Address .,....a ---.a.., "'" '" '"' """"" 777 S. Main Stop Suite 1,06 BUILDING: TYPE CONST.- A.P. Number Legal Description Project Description OCC. GRP. 613-790-006 �R ����'a ng City �3 nge. Zip 92696 Tel. 714547- 056 Contractor Sam Address ., AMOUNT Plan Chk..Dep.\ City Plan Chk. Bal. Zip Tel. JV4 V _ Mech. State Lic. & Classif. 462814 City Lic. # - 763 Sq. Ft. Size No. No. Dw.-- Stories Units Arch., Engr., Designer J .'06 New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Address Tel. City Zip 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 SIGNATURE DATE f 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 rile a signed statement that he is licensed pursuant to the provisions or the Contractor's License Law, Chapter 9 (commencing with Section 7000) or 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 or not more than five hundred dollars ($500). ❑ 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 or 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.) 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-•) ❑ 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 thg 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 or 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 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 Grading Driveway Enc. Infrastructure � � r5�' •�'.�y Frlitgo—YRe f'sfur" V a V Estimated Valuation $560896 PERMIT AMOUNT Plan Chk..Dep.\ Plan Chk. Bal. T • ' Const. JV4 V _ Mech. X33 a UU! Electrical 4J . JU Plumbing U> $ . Liu S.M.I. J .'06 Grading Driveway Enc. Infrastructure � � r5�' •�'.�y Frlitgo—YRe f'sfur" V a V TOTAL i�Av.1±laE: 1 `{� (• j REMARKS ° ZONE: BY: Minimum Setback Distances: Front Setback from Center Line Rear Setback,from:Rear .Prop . Line-- - 4;x�r.,aY'tf.S�'N .ka,x5�,1?1.L= �+�: e�*�ir.r. i ••• Side Street Setback from Center Line Side Setback from Property Line FINAL DATE �N,S,P18CT8_OR Issued by: Date I Permit Validated by: Validation: WHITE - FINANCE, PINK - APPLICANT, GREEN - BUILDING, GOLDENROD - ASSESSOR'S OFFICE, HARD COPY - FILE ; CONSTRUCTION ESTIMATE NO. .ELECTRICAL FEES] .- NO. PLUMBING FEES IST FL SO FT y $ . �1= UNITS COLL. AREA SLAB GRADE / f�� ROUGH PLUMB ' YARD SPKLR SYSTEM 2ND FL SO FT. � HEATING (ROUGH) STORAGE TANK FORMS MOBILEHOME SVC. BAR SINK ' POR SO FT at DUCT WORK ROCK STORAGE FOUND. REINF. % i, [ POWER OUTLET ROOF DRAINS GAR SO. FT. it HEATING (FINAL) OTHER APP.IEOUIP. REINF. STEEL GAS (FINAL) DRAINAGE PIPING CAR P. SO FT. WALL SO. FT. @ - DRINKING FOUNTAIN FINAL INSP. URINAL SO. FT. a WATER SYSTEM ESTIMATED CONSTRUCTION VALUATION $ GRADING cu. yd. $ plus x$ WATER PIPING NOTE: Not to be used as properly tax valuation FINAL INSP.' LL/( Cd FLOOR DRAIN MECHANICAL FEES ROOFING WATER SOFTENER VENT SYSTEM FAN EVAP.0OOL HOOD SIGN WASHER(AUTONDISH) APPLIANCE DRYER VENTILATION GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED LAUNDRY TRAY AIR HANDLING UNIT CFM I IKITCHEN 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. 0 c BATH TUB SO. FT. @ c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID 1'A c SEWAGE DISPOSAL SO.FT.GAR Y4c HOUSE SEWER FINISH GRADING ` GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEE MECH.FEE PL.CK.FEE CONST. FEE ELECT. FEE SMITFF--j PLUMB FEE STRUCTURE PLUMBING ELECTRICAL HEATING 8 AIR COND. SOLAR SETBACK GROUND PL UNGUNDERGROUND A.C. UNIT COLL. AREA SLAB GRADE / f�� ROUGH PLUMB BONDING HEATING (ROUGH) STORAGE TANK FORMS SEWER OR SEPTIC TANK ROUGH WIRING DUCT WORK ROCK STORAGE FOUND. REINF. % i, [ S (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$ -$ LUMBER GR. FINAL INSP.' LL/( Cd FRAMING lV //%7 1 c� [ FINAL INSP. ROOFING I REMARKS:, VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING [# (ON 1 MESH INSULATIONISOUND ©d� L C FINISH GRADING FINAL INSPECTIONS Z� CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL