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003453 (BLCK)�A7. Building _ Address Owner T4'ht 4.4 Q%dA& P.O. BOX 1504 78-105 CALLE ESTADO LA QUINTA, CALIFORNIA 92253 KZMEN $ADAM FOSTER Mailing Address 1 • Contractor DAN RARRM Address . City Zip -- ._ LA QD'Yz�Ta 92253 564--2153 No. 003453 BUILDING: TYPE CONST. OCC: GRP: A.P. Number 773—t)3�1i5 Legal Description Project Description ;VAOI of All. 'RT !9TAt4 S*AT.7. State Lic. City & Classif.378318 Lic. # 1$9 Sq. Ft. Size • No. No. Dw. Stories • Units :, - ArchEngr., Designer . New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Address Tel. I City Zip State L-ic. # LICENSED CONTRACTOR'-$. DECLARATION I hereby affirm that I am licensed under provisions ofiChapter 9 (commencing with Section • .7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. d SIGNATURE K - _ o^ DATE 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, and, 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 the provisions of the Contractor's License Law, Chapter9 (commencing with Section 7000) of Division 3 of the Business and Professions Code,. or that. he is exempt lheWrom, and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit r ' subjects the applicant to a civil penalty of not more than five hundred dollars (5500).- ❑ I, as owner of the property, or my employees with wages as their sole compensation, will Estimated Valuation +! ��� # PERMIT.. .r ' 'AMOUNT _ - Plan Chk. Dep. - - PIaLi Chk. Bal. 4s5.7 Const.^ ' 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 . Mech. ' _ tiuiids or improves thereon and who does such work himself or, through his own employees, r° provided that such improvements are not Intended or offered for sale. If, however, the building Electrical 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.) Plumbing i O I, as owner of the property, am exclusively contracting with licensed contractors to con- struct the project. (Sec. 7044, Business end -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. _ - ` ••^ � � 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. p Certified copy is hereby furnished. TOTAL REMARKS CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars (3100) 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. ZONE: BY: ' Minimum Setback Distances: ' Front Setback from Center Line Rear Setback from Rear Prop. Line CONSTRUCTION LENDING AGENCY - Side Street Setback.from Center Line 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.) - Side Setback from Property Line Lender's Name Lender's Address FINAL DATE Issued by: Validated by: INSPECTOR �� Date permit. ' 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. . rQ 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 Validation: City, State, Zip HARD COPY CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SQ. FT. ® $ UNITS SLAB GRADE ROUGH PLUMB. BONDING YARD SPKLR SYSTEM 2ND FL. SQ. FT. ® FORMS SEWER OR SEPTIC TANK ROUGH WIRING MOBILEHOME SVC. BAR SINK POR. SO. FT. ® GAS (ROUGH) METER LOOP GAR. SO. FT. ® POWER OUTLET ROOF DRAINS AS (FINAL) TEMP. POLE DRAINAGE PIPING CAR P. SO. FT. ® GROUT WATER HEATER WALL SQ. FT. ® FINAL INSP. DRINKING FOUNTAIN SQ. FT. 0 ATER SYSTEMWk 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.000L HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED LAUNDRY TRAY AIR HANDLING UNIT CFM FIRE ZONE ROOFING 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 LATHING SQ. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SQ. FT. RESID ® 11/4 c SEWAGE DISPOSAL SQ.FT.GAR ® 3/4c HOUSE SEWER FINISH GRADING GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEE MECH.FEE PL.CK.FEE __JCONST. 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 APPJEOUIP. RE NF. STEEL AS (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM?j `� ATER SYSTEMWk GRADING CU. yd. $ plus x$ _$ LUMBER GR. lc'?_0774D1 ^�./ ee FINAL INSP. FRAMING FINAL INSP. ROOFING REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATION/SOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS, GARDEN WALL FINAL