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06078 (BLCK)Building 78-I81 La Fonda P.O. BOX 1504 78-105 CALLE ESTADO LA QUINTA, CALIFORNIA 92253 Owner Michael A. Fischer Mailing Address City Zip Tel. Contractor City lZip I Tel.: State Lic. (City & Classif. Lic. # Designer Address I 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 OWNEWBUILDER 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, atter, Improve, demolish, or repair any structure, prior to its issuance also requires the applicant for such permit to lie a signed statement that he is licensed pursuant to the provisions of the Contractor's License taw, 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 (5500). r ❑ 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 safe. N 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 irprove 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 Contractors License Law does not apply to an owner of property who buikfs or improves thereon, and who contracts for such projects with a contractorfs) fcensed pursuant to the Contractors License Law.) f ❑ 1 am exempt under Sec_ N w_ & P.C. for this reaso ! lr0 a � r Date :24*' 1 f O1 f ' Owner C'—' f f F )V,4 ,s'tr d lilri i k , 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 (rhis section need not be completed ff the peril is for one hundred dollars ($100) valuation or less.) I certify that in the performance of the work for which this,,pp- it is issued, I shall not employ any person in any manner so as to bdcome subj t toot a Workers' Compensation Laws of California f t R r Date Owner NOTICE TO APPLICANT- tt, after mating M Cenilicafe of "Exemption you should become subject to the Workers' Compensation provkions of the Labor Code, you must forthwith comply with such provisions or this permit shag 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, Chd Code.) . Lender's Name Lender's Address This is a building permit when property 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 No. 080?8 BUILDING: TYPE CONST. OCC: GRP._ Number 709-085-003 .egal Description project Description1870 of chain link fence. Plontm - to he installed prig to fina3. Sq. Ft. No. No. Dw- Size Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition Estimated Valuation S 1 32 PERMIT AMOUNT Plan Chk. Dep Plan Chk. Bal. Const. Mech. .00 Electrical Plumbing S.M.I. .50 Grading Driveway Enc. Infrastructure TOTAL 4 '> • �ti REMARKS r _Al rt Lt'i '4 f3 ? ti?..i f — 39 ) 4 f MOUNT TENDERED 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 DATE INSPECTOR Issued by: Date 7/11/99 Permit Validated by: Validation: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES PLUMBING FEES 1ST FL. SQ. FT. ® $ UNITS r ROUGH PLUMB. BONDING YARD SPKLR SYSTEM 2ND FL. SQ. FT. FORMS SEWER OR SEPTIC TANK ROUGH WIRING MOBILEHOME SVC. BAR SINK POR. SQ. FT. ® GAS (ROUGH) METER LOOP GAR. SQ. FT. ® POWER OUTLET ROOF DRAINS GAS (FINAL) TEMP. POLE DRAINAGE PIPING CAR P. SQ. FT. ® GROUT WATER HEATER WALL SO. FT. ® FINAL INSP. DRINKING FOUNTAIN BOND BEAM WATER SYSTEM URINAL SQ FT ® LUMBER GR. ESTIMATED CONSTRUCTION VALUATION $ FINAL INSP. WATER PIPING NOTE: Not to be used as property tax valuation FLOOR DRAIN MECHANICAL FEES WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER VENTILATION GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED FIRE ZONE ROOFING LAUNDRYTRAY AIR HANDLING UNIT CFM FIREPLACE 1KITCHEN 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. SQ. FT. ® c BATH TUB SO. FT. ®c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SQ. FT. RESID ® 1Vi c SEWAGE DISPOSAL SQ.FT.GAR ® V4c 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 W DATE: Tw�p4ZIP a" SERVICE REQUEST J t 1. j ^ " (v� ✓ ROUTINE dam- b•- / URGENT: CONKJNITY DEVELOPMENT BUILDING Construction during prohibited hours Construction of w/o a permit Excess debris on construction site Excess blowing sand Dilapidated or unsafe structure Fire damaged structure ENGINEERING/STREETS Missing or damaged street sign Malfunctioning traffic signal Malfunctioning street light Pothole or other street repair Debris on the roadway Faded striping or other traffic markings Obstruction to sight -distance along roadway Drainage problem Unsafe traffic condition PLANNING Establishment of illegal use Establishment of illegal sign COMMUNITY SAFETY ANIMAL CONTROL Loose dog(s) Barking dog(s) Trapped or contained animal(s) Dead animal(s) Animal bite •. 2.iIIs)001 iula�Yi Trash problem Debris on lot Weeds on lot Abandoned/junk vehicle(s) Mechanical work on cars in residential area Lack of business license SAFETY Fire hazard Need for sheriff j,d'ys� OTHER • Sr,- >i Co20S Atj 0 Uvi-Sr aL2��m iJoo I �sLte4 Location of problem: Description (if necessary): Disposition of problem:daeaq R I462/i OECEIVEID JUtjo, CI ! '989, P��rH� c C3� LA QUIN �?QILOAWq FPS - Staff Sign ture: Date: 1 , 4 1st copy -Department 3rd copy -City Manager 2nd copy-Department/to be sent to City Mgr. with disposition 4th copy -Reporting Party A rvo