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12183 (RPL)4 P.O. BOX 1504 `� N o , 12183 Address a 78-765 LA PALMA LA QUINTA, CALIFORNIA 92253 Owner Mailing GAMMA CARTMIGHT BUILDING: TYPE CONST. OCC: GRP. Address 78-765 IA PAL14A A.P. Number City - Zip Tel. LA Qv °A 92253 Legal Description Contractor VALLEY =L &?4D SPA � Project Description .Address 4741 EAST PALM CANTf3N ' - CityPALM eP�G Zlp 92264 Tel• 778""3939 State Lic. City & Classif. A359105 Lic. # 2,565 __ Sq. Ft. No. No. Dw. -- . Arch.; Engr., Size Stories Units De'sign'er New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Address Tel. City Zip State t Lic. # -, LICENSED CONTRACTOR'S DECLARATION I hereby affirm thatrl am licensed under provisions of Chapter 9 (commencing with Section 7000)"Of Division 3 of thi Business and Professions Code, and my license is in full force and SIGNATURE DATE OWNER -BUILDER DECLARATION Estimated Valuation I hereby affirm that I am exempt from the Contractor's License Law for the following 9 +. reason: (Sec. 7031.5,Buslness and Professions Code: Any city ori county which =requires a IS 0 n . 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 PERMIT AMOUNT the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of r 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 Plan Chk. Dep. subjects the applicant to a civil penalty of not more than live hundred dollars ($500). O I, as owner of the property, or my employees with wages as their sole compensation, will Plan Chk. Bal. do the work, and the structure is not intended or offered for sale. (Sec. 7044, Bulsness and Const. 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, Mech. 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 Electrical 4nof 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- Plumbing 21.011 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 .S•M•1. Q such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) ❑ I am exempt under Sec. B. 8 P.C. for this reason Grading Driveway Enc. Date owner Infrastructure 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 O Copy is filed with the city. O,Certified copy is hereby furnished. TOTAL S200. 20 CERTIFICATE OF EXEMPTION FROM REMARKS 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: ,s�j� Date orf Y ' NOTICE TO APPLICANT: If!'after making this Certificate of Exemp1bn-3r should become ZONE: BY: I subject to the Workers, -Compensation this permit provisions d the Labor code, you must forthwith Minimum Setback Distances: AUG i7_119003 comply with such provisions or this permit shall be deemed revoked. . Front Setback from nter Line /"'it A Rear Setback from ear Prop. Line CONSTRUCTION LENDING AGENCY Side Street Setback I hereby affirm that there is a construction lending agency for the performance of the / work for which this permit is issued. (Sec. 3097, CIO Code.) -Side Setback from Property Lender's Name Lender's,r Address This is a building permit when properly filled out, signed and validated, and is subject to FINAL DATE INSPECTOR -' 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 ,l agree to comply with all city and county ordinances and state laws relating to building L construction, and hereby authorize representatives -of this city to enter the above-. mentioned property for inspection purposes. Validated by: Signature of applicant Date Mailing Address Validation: City, State, Zip CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SO. FT. p $ UNITS SLAB GRADE ROUGH PLUMB. BONDING YARD SPKLR SYSTEM 2ND FL. SD. FT. FORMS SEWER OR SEPTIC TANK ROUGH WIRING. MOBILEHOME SVC. BAR SINK POR. SQ. FT. ® GAS (ROUGH) METER LOOP GAR. SO. FT. ® POWER OUTLET ROOF DRAINS GAS (FINAL) TEMP. POLE DRAINAGE PIPING CAR P. I SQ. FT. GROUT WATER HEATER WALL SQ. FT. FINAL INSP. DRINKING FOUNTAIN. SQ FT ® WATER SYSTEM URINAL ESTIMATED CONSTRUCTION VALUATION $ WATER PIPING NOTE: Not to be used as property tax valuation FINAL INSP. FLOOR DRAIN MECHANICAL FEES WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED VENTILATION LAUNDRYTRAY AIR HANDLING UNIT CFM FIRE ZONE ROOFING: 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 LATHING SQ. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 11/4 c SEWAGE DISPOSAL SO.FT.GAR ® 3/ac 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 GROUND PLUMBING UNDERGROUND A.C. UNIT COLL. AREA SLAB GRADE 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 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 SIGNATURESIINITIALS GARDEN WALL FINAL