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9417 (SFD).�W Q /� ci ' P.O. BOX 1504 No. 9417 Building�. 7&105 CALLE ESTADO Address �' 8'- 950 Bel Monte Court LA QUINTA, CALIFORNIA 92253 Owner `` . J Brock BUILDING: TYPE CONST. OCC: GRP. Mailing Address A.P. Number City ✓` dip `_. Tel. �.- Legal Description c3...,, k Project Description Lot I J Model 2DR SAME Address City Zip Tel:: State Lic. City & Classif. $Z Lic.#��® Sq. Ft. No. No. Dw. Arch., Engr., Size 2283 Stories Units Designer New ❑ Add ❑ Alter ❑ Repair O Demolition ❑ Address Tel. City Zips., State Lic. # ! LICENSED CONTRACTOR'S DECLARATION f I hereby. affirm that.l,am,libensed under provisions of Chapter 9 (comment iny,wilh.Segtion 7000) pf'Division--33,of`the`Bu�ssiin'ess� a and Professions Code, and my Ii in in'fulUt icc�a and / DATE OWNER -BUILDER. DECLARATION I hereby affirm that I am exempt. from thXContractor•s License Law for the following Estimated Valuation �� . �Q reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a t permit to construct, atter, 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 - PERMIT AMOUNT the provisions of the Contractor's License Law, 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 Plan Chk. Dep. subjects the applicant to a civil penalty of not more than five hundred dollars.(8500). l • ❑ 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, .Buisness and Const. 1314 • U ' 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,Mech. - • U U 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. d!) of proving that he did not build or improve for the purpose of sale.). ' ❑ 1, as owner of the property, am exclusl4ely 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.I. 1. 69 such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) Grading ❑ 1 am exempt under Sec. • B. & P.C. for this reason Driveway Enc. Date owner Infrastructure 37.bb Art in PuDlic 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 V x is ; v. i 4 O'Copy.is filed with the city. O Certified copy is hereby furnished. i(Y tX3if "'"ACI ,.9i TOTAL _ 4 `-f 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 the 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 of 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 car Illy 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, StatC`' Zip 1 REMARKS 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 Permit Validated by: Validation: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST Ft. SO. FT. ® $ UNITS COLL. AREA 2ND FL. SO. FT. ROUGH PLUMB. YARD SPKLR SYSTEM MOBILEHOME SVC. BAR SINK POR. SO. FT. ® SEWER OR SEPTIC TANK ROUGH WIRING. GAR. SO. FT. ® POWER OUTLET ROOF DRAINS // FOUND. REINF.C [= GAS (ROUGH) -4-1 � DRAINAGE PIPING CARP. S0. FT. HEATING (FINAL) OTHER APPJEOUIP. WALL SO. FT. GAS (FINAL) DRINKING FOUNTAIN, SO FT ® URINAL ESTIMATED CONSTRUCTION VALUATION $ WATER HEATER WATER PIPING NOTE: Not to be used as property tax valuation FINAL INSP. FLOOR DRAIN MECHANICAL FEES WATER SYSTEM WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED FINAL INSP. LAUNDRYTRAY AIR HANDLING UNIT CFM J y ) �j✓ + l 1 —�"` h KITCHEN SINK ABSORPTION SYSTEM B.T.U. TEMP USE PERMIT SVC WATER CLOSET COMPRESSOR HP POLE, TEM/PERM 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 ® 1% c SEWAGE DISPOSAL GAR. FIREWALL SO.FT.GAR ® 3/ac HOUSE SEWER LATHING 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 ROUND PLUMB14K-e/1-� UNDERGROUND A.C. UNIT COLL. AREA SLAB GRADE G - � ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMS SEWER OR SEPTIC TANK ROUGH WIRING. DUCT WORK ROCK STORAGE // FOUND. REINF.C [= GAS (ROUGH) -4-1 � METER LOOP HEATING (FINAL) OTHER APPJEOUIP. REINF. STEEL GAS (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM $ GRADING cu..yd. plus x$ _ $ LUMBER GR. AL INSP. ��_ MING G / `1 ^ v ( FINAL INSP. ROOFING � -024 -q/ J y ) �j✓ + l 1 —�"` h REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH AISULATIONISOUND FINISH GRADING FINAL INSPECTION ERT. OCC. -FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS h' GARDEN WALL FINAL