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003292 (CRES)Building Address 4"80 JUF ON Owner TCM SPURGI4 Mailing Address SAME City Zip I& QUIRTA . ... 92253 Contractor OWNERIBUILDER Address SAM . .. Zip P.O. BOX 1504 No.- 78-105 CALLE ESTADO 9. LA QUINTA, CALIFORNIA 92253 I. Tel. BUILDING: -TYPE CONST. OCC: GRP. A.P. Number 617-160-009 Legal Description Project Description M POR` State Lic. City WORKERS' COMPENSATION INSURANCE & Classif. Lic. # Sq. Ft. 302 No. No. Dw. or less.)- - I certify that in the performance of thg work for which this permit is issued, I shall not Size Stories Units Arch., Engr.; Designer New ❑ Add EU Alter ❑ Repair ❑ Demolition ❑ Address Tel. NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become ZONE: BY: subject to the Workers' Compensation provisions of 'the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. ' Minimum Setback Distances: City Zip State Lic: # CONSTRUCTION LENDING AGENCY. •,- _ LICENSED CONTRACTOR'S DECLARATION hereby affirm that there is a construction lending agency for the performance of the - I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section ' work for which this permit is issued. (Sec.,3097, Civil Code.) 7000)of Division 3 of the Business and Professions Code; and my license is in full force and Lender's Name - effect. . Lender's Address This is a building permit'when properly filled out, signed and validated, and is subject to FINAL DATE SIGNATURE DATE expiration it work thereunder is suspended for 180 days. OWNER -BUILDER DECLARATION Estimated Valuation Issued by: I hereby affirm that I am exempt from the Contractor's License Law for the following I agree to comply with all city and county ordinances and state laws relating to building 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 mentioned property for inspection purposes. Validated by: 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 Mailing Address - Division 3 of the Business and Professions Code, or that.be'is exempt therefrom, and the basis' for the Any Section 7031.5 'any Plan Chk. Dep. - - alleged exemption. violation of by applicant for a permit `subjects the applicant to a civil penalty of not more than five hundred dollars (8500). - '- Plan Chk. Bal. .. 23.92, ,q 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 Const. 44.50 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 " 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- Plumbing • 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• such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) • .� Grading ❑ I am exempt under Sec. B. 8 P.C. for this reason / !'t Driveway Enc. 1:---�+.» -�•�. Date l>= •G .F 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 ❑ Copy is.filed with the city. ❑_Certified.copy is hereby furnished. TOTAL 73.92 CERTIFICATE OF EXEMPTION FROM REMARKS WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars (8100) valuation or less.)- - I certify that in the performance of thg work for which this permit is issued, I shall not S�dt � :145 F7,:, lei 010,1 T �1� Yui �� r7 c��► 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 ZONE: BY: subject to the Workers' Compensation provisions of 'the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. ' Minimum Setback Distances: Front Setback from Center Line Rear Setback from Rear Prop. Line CONSTRUCTION LENDING AGENCY. Side Street Setback from Center Line 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.) ' Side Setback from Property Line Lender's Name . Lender's Address This is a building permit'when properly filled out, signed and validated, and is subject to FINAL DATE INSPECTOR 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. Issued by: Date 712111$0 Permit 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. Validated by: Signature of applicant _ Date Mailing Address Validation: City, State, Zip HARD COPY CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SQ. Ff. $ 2ND FL. SQ. FT. p FOR. SO. FT. ® GAR. SO. FT. p CAR P. I SQ. FT. WALL SO. FT. ® SQ, FT. ® ESTIMATED CONSTRUCTION VALUATION $ UNITS MOBILEHOME SVC. POWER OUTLET YARD SPKLR SYSTEM BAR SINK ROOF DRAINS DRAINAGE PIPING DRINKING FOUNTAIN URINAL WATER PIPING NOTE: Not to be used as property tax valuation BONDING FLOOR DRAIN MECHANICAL FEES FORMS WATER SOFTENER VENT SYSTEM FAN EVAP.000L HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER GAS (ROUGH) GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED OTHER APPJEQUIP. LAUNDRY TRAY AIR HANDLING UNIT CFM TEMP. POLE IKITCHEN SINK ABSORPTION SYSTEM, B.T.U. TEMP USE PERMIT SVC I WATER CLOSET' COMPRESSOR HP POLE ,TEM/PERM LAVATORY HEATING SYSTEM FORCED GRAVITY AMPERES SERV ENT SHOWER BOILER. B.T.U. SQ. FT. ®c BATH TUB SQ. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 1Va c ' SEWAGE DISPOSAL SQ.FT.GAR p 3/4c HOUSE SEWER REMARKS: 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 _ nn// r FINAL INSPECTION�;C�. '/ c' CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL 1 5 , _ (TV e� , �'�.a e 07Lvd � CoNG�tEfE .Jd _ v h d Gtr e LA'S e- 0 [,,4 G- Boi-f ,Co 7o �7:t FOAC • SPAS -77V/r I• i 1► - a X r v � a,��rS G� ay ,� C �� 2� AsaLl�- 1 y x FIE 1 A: 44, L t aa' s W 1