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06652 (BLCK)r 44 P.O. BOX 1504 No. 06652 Building78-105 CALLE ESTADO Address 54'-700 Draw LA QUINTA, CALIFORNIA 92253 Owner Mailing sm ccaft . " - BUILDING: TYPE CONST. •OCC. GRP. • Address P. 0. B= 804 A.P. Number 774-272-010 CityTel. La Zip Quints 92233 564-4977 Legal Description Contractor Project Description 3' X 1t}tS• ratalIntina raanili Address City Zip Tela State Lic. City & Classif. Lic. # Sq. Ft. No. No. Dw. Size Stories Units Arch., Engr., Designer New ❑ Add ❑ Alter ❑ Repair ❑ -Demolition ❑ Address 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 OWNIMBUILDER DECLARATION Estimated Valuation I hereby affirdn that I am exempt from the Contractofs License Law for the following QI .C�® reason: (Sec., 7031.5,Busi7ess and professions Code: Any city or county which requires a - ori f permit to construct, after, bwrove, demro6sh, or repair any structure, prior to its issuance also requires the applicant for such permit to me a signed statement that hes licensed pursuant to PERMIT AMOUNT the provisions of the Contractor's license Law, Chapter 9 (commencing with Section 7000) of lkvisfon 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. sut yects the applicant to a civil penalty of not more than five hundred dollars (5500). ❑ 1, as owner of the property, or my employees with wages as their sole compensation, will Plan Chk. Bal. 1� lin0 do the work, and the structure is not Intended or offered for sale. (Sec. 7044, Buisness and Const. $45T •0 Professions Code: The Contractor's License Law does not appy to an owner of property who builds or inproves thereon and wt does such work himself or through his own employees, Mech. provided that such unprovements are not intended or offered for sale. ff, however, the building or improvement is sold wither one year of completion, the owner-budder 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 bmMs or bnproves thereon, and who contracts for S.M.I. .14 such projects with a contractors) licensed pursuant to the Contractor's License Law.) Grading ❑ I am exempt under Sec B. 8 P.C. for this reason 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, ora certified copy thereof. (Sec. 3800, Labor Code.) Policy No Company ❑ Copy is filed with the city. ❑ Certified copy is hereby furnished. TOTAL CERTIFICATE OF EXEMPTION FROM REMARKS WORKERS'COMPENSATIONINSURANCE >� (This section need not be completed ff the permit is for one hundred dollars ($100) valuation ' E (,� m1 9c# r {.lt_.�tF(l y 1^A;}•'t,3T` �-i or less.) S. MFS S . ! 4 % A F? !f i A r`i I M. 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: n, 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 I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, CW Code.) Side.Setback.from Property Line Lender's Name Lenders Address FINAL DATE INSPECTOR This is a building permit when properly filled out, signed and validated, and is subject to tf expiration if work thereunder is suspended for 180 days. 11/15/89 permit certify that I have read this application' and state that the above information is correct. Issued by: Date 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 CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES IST FL. SO. FT. ® $ UNITS r SLAB GRADE ROUGH PLUMB. YARD SPKLR SYSTEM 2ND FL. SO. FT. @ HEATING (ROUGH) STORAGE TANK FORMS MOBILEHOME SVC. BAR SINK POR. SO, FT. ® DUCT WORK ROCK STORAGE GAR. SO. FT, ® POWER OUTLET ROOF DRAINS METER LOOP HEATING (FINAL) DRAINAGE PIPING CAR P. I SO. FT. GAS (FINAL) WALL SQ. FT. DRINKING FOUNTAIN FT ® WATER HEATER URINAL ESTIMATED CONSTRUCTION VALUATION $ FINAL INSP. WATER PIPING NOTE: Not to be used as property tax valuation WATER SYSTEM FLOOR DRAIN MECHANICAL FEES GRADING cu. yd. $ Plus -X$-=$ WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER FINAL INSP. GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED j' Il %, •" /!I^�'V JAL �✓ _ j AA,A� 1�1v„ LAUNDRYTRAY AIR HANDLING UNIT CFM REMARKS: 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. SO. FT. ® c BATH TUB SO. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 11/4 c SEWAGE DISPOSAL SQ.FT.GAR ® 3/ic HOUSE SEWER GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE DBL ]-- TOTAL FEES MICRO FEE MECH.FEE PLCK.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 APP.IEQUIP. 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 j' Il %, •" /!I^�'V JAL �✓ _ j AA,A� 1�1v„ ��/� �/4 / `? /�/ �� «<j!A //�� 1/3-/`/ i� `Z 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 I