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002990 (RER)Building 54'17=P Address mr4ilaa Dim Owner E T+...rn" Stams P.O. BOX 1504 78-105 CALLE ESTADO LA QUINTA, CALIFORNIA 92253 Mailing Address } City Zip Tel. Sme &'*ice Sim Contractor 1 -A t2 Smith.'�CI1�St�2C't.f [}7 t Address +69-•877 SuW. Areis City Zip Tel. Cath -_&'c Citv 92234 32C-4728 State Lic. City & Classif. 3{35281 B Lic. # . 958 Arch., Engr., Designer Address Tel. City Zip State III Lie. # LICENSED CONTRACTOR'S DECLARATION 1 hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section effec 7000) t. . of Division 3 of the Business and Professions Code, and my license is in full force and �( SIGNATURE 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, after, improve, demolish, or repair any structure, prior to its issuance also requires the applicant for such permit to fde a signed statement that he is licensed pursuant to 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. fie 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 ($500). ❑ 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 sale. If, however, the building or improvement is sold within one year or completion, the owner -builder will have the burden of proving that he did not build or inprove for the purpose of sale.) D _t ❑ 1, as owner of the property, am exclusively contracting with licensed contractors to con- 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 such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) li O 1 am exempt under Sec. B. & P.C. for this reason Date Owner �( WORKERS' COMPENSATION DECLARATION 1' 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 0 Copy is filed with the city. ❑ Certified copy is hereby furnished. 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 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. 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 cerIily 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 ateMailing Address City, State, Zip No. 002990 BUILDING: TYPE CONST. OCC. GRP. A.P. Number 714--201-009 (Legal Description 10 Project Description Irmalat:e czd DAY & to:tum P&I footimp to existing slab Md Sliding do= .M elwtr cut:1+ot & out:ulds lata a Ei rat i Sq. Ft. No. No. Dw. Size Stories Units New ❑ Add ❑ Alter 9= Repair ❑ Demolition ❑ Estimated Valuation PERMIT AMOUNT Plan Chk. Dep. - Plan Chk. Bal. Const. 50.50 Mech. 10.00 Electrical 12.00 Plumbing S.M.I. - .50 Grading Driveway Enc. Infrastructure TOTAL 105.82 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 3116/87 Permit Validated by: Validation: A 7 5 3 7 3 16 i i. 5,82 it HARD COPY I T CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SO. FT. ® $ UNITS SLAB GRADE ROUGH PLUMB. BONDING YARD SPKLR SYSTEM 2ND FL. SD. FT. FORMS SEWER OR SEPTIC TANK POR. SO. FT. @ MOBILEHOME SVC. BAR SINK GAR. SO. FT. ® POWER OUTLET ROOF DRAINS HEATING (FINAL) OTHER APPJEQUIP. DRAINAGE PIPING CAR P. I SQ. FT. ® TEMP. POLE WALL SQ. FT. ® GROUT DRINKING FOUNTAIN SO. FT. ® FINAL INSP. URINAL ESTIMATED CONSTRUCTION VALUATION $ WATER SYSTEM WATER PIPING NOTE: Not to be used as property tax valuation =$ FLOOR DRAIN MECHANICAL FEES FINAL INSP. WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASH ER(AUTO)(DISH) APPLIANCE DRYER GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED LAUNDRY TRAY AIR HANDLING UNIT CFM 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. SQ. FT. ® c BATH TUB GAR. FIREWALL SO. FT. ®c I WATER HEATER MAX. HEATER OUTPUT, B.T.U. SQ. FT. RESID ® 1 Va c SEWAGE DISPOSAL MESH SO.FT.GAR ® 3/ac HOUSE SEWER GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEE --f—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 OUGH WIRING DUCT WORK ROCK STORAGE 0%/_FOUND. REINF. �`�.� r 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 SIGNATURES/INITIALS. GARDEN WALL FINAL Building Address Owner I Mailing Address City lityl 4 4 Q14 P.O. BOX 1504 78-105 CALLE ESTADO LA QUINTA, CALIFORNIA 92253 c5 7— C Zip Contractor Address 0 _ 1— 8'� /n State Lic._ City & Classif. 305 2 I! Al Lic. Arch., Engr., Designer Address I Tel. CityI Zip I State Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing with Section 7000) of Div s^ loon of the Inpss and Professions Code, and my licen a is in full � effect. •C 3 SIGNATURE DATE OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason: (Sec. 7031.5,Susiness and Professions Code: Any city of county which requires a permit to construct, alter, 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 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 Subjects the applicant to a civil penalty of not more than five hundred dollars ($500). ❑ 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 (hereon and who does such work himself or through his own employees, provided that such improvements are not intended or offered for sale. If, however, the building orImprovement 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.) O I, as owner of the property, am exclusively contracting with licensed contractors to con- 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 such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) ❑ 1 am exempt under Sec. B. & P.C. for this reason Date Owner 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. ❑ Certified copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed it 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. alter 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 1 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 it 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 FINANCE APPLICATION ONLY BUILDING: TYPE CONST. OCC. GRP, A.P. Number �s n Legal Description Project Description Sq. Ft. No. No. Dw. Size Stories Units New ❑ Add ❑ Alter )d Repair ❑ Demolition ❑ d Ftt,,DtofY,s 7-6 imsfi-I'VSAih 4( ��/It�lNli 00ble 4 S4IHr 0/4o - Texl'-we A0/1 a UfilcT r o&74 o,ye �4��c' f srt4?p/! 61 Estimated Valuation PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. 3 Z, Const. 9C "o ,y' d Mech. Q . 00 Electrical 62_ DO Plumbing S.M.I. — Ej Grading Driveway Enc. Infrastructure TOTAL / D 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: n } rt— A -LOW rtF- n. O G S O (D r• C rr r- A C (n (D S m a (D n O rt M r• r• n v (D O H O 7 7 �� �• r- a� S O O. La rt m (D r- rt G `C rt a n m a m a n rt to rt to r- O r- (D n rr (D A u••n to r• O 7 rr r• a rt (D - rt \ Fa-' O rr A rr a A r � rO'h O. y � n En 'O rr (D CJ a r- p, n r• rh (D A (CD N D (n [ r rt r C A O @ S of O rt ((DD C a FO- O (D (D r j rt F-• O rh O rt a ro O r- 7 rt (n (D rt O A 'C S a G Cl) Z a rD rh Q n A (D (D (D rr (D, rt r• rn r• S n, O to a (D r- rn r* (D G rt (n (D Q w O a G O O rn F•- rh OD (D Q r O o, r• r- �v K O :1 c ry O to G rt rn n ro n S G (D (D (D a u- n rn 7 n r• 0. 3 r-rt (D O rt£ D) rn O G O S r- r- Fh r- rt rr 1-- A A O a S rr S rt n O (D S r- M r• r- O O 7 y 7 n -- H O rJvc� a CO (D r- 1 10 rt 10 F- a 'C G O n r- cn rt O 7 9 rh rt C� rD a a : r F- rr a D N n+ 10 [i] r cn C) G �O rt O rt In O G w a r- rt K v (D C rD H O �o (D z rr v H [TJ v M 0