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002673 (BLCK)' Building x-920 Avemida DiaZ Address LL Owner P.O. BOX 1504 No. 002673 78-105 CALLE ESTADO LA QUINTA, CALIFORNIA 92253 Pie crwk D.�laprmt BUILDING: TYPE CONST. OCC: GRP. Mailing Address 51-625 %&SW*K*X-T DriV% A.P. Number 774-291-009 CityouintZip Tel. 922 Legal Description Lot 16 TA .Contractor Project Description Address .. 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 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 j Date Mailing Address City, State, Zip I HARD COPY I ZONE: T BY: -City Zip _. .. Tela 1$ Minta 922 592 -ms State Lic. City FINAL.DATE & Classif. ' Lic. # 680 Sq. Ft. No. No. Dw. Size W • •Stories i . Arch., Engr.; • Units Designer New p Add ❑ Alter ❑. Repair ❑ Demolition ❑ Address Tel.W 11Z6of 4— high Ali link feWe City Zip State to be '8=isaind by iegaUtictg, _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 t effect. i A _SIGNATURE - DATE 1 OWNER -BUILDER DECLARATION Estimated Valuation 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 Y • • permit to construct, alter, improve, demolish, 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 PERMIT - - AMOUNT the provisions of the Contractor's License Law, Chapter 9 •(commencing with Section 7000) of Division 3of'the Business and Professions Code, or that, he is exempt therefrom, and the basis for Any Section 7031.5 'any for plan.Chk. De ' p the alleged exemption. violation of by applicant a. permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500). ' .. -' Plan Chk. Bal. ❑ 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. r.•�� 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 offeredfor 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 �S.M:I. 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.) Grading I p 1 am exempt under Sec. - B. & P.C. for this reason Driveway Enc. Date Owner Infrastructure WORKERS' COMPENSATION DECLARATION I 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. - TOTA L 20.00 CERTIFICATE OF EXEMPTION FROM ..REMARKS' 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 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 j Date Mailing Address City, State, Zip I HARD COPY I ZONE: T 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: A.66.36 _1.1 .3 20,00_' Ck CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES IST FL. SQ. FT. ® $ UNITS SLAB GRADE ROUGH PLUMB. BONDING YARD SPKLR SYSTEM 2ND FL. SQ. FT. ® FORMS SEWER OR SEPTIC TANK POR. SO. FT. ® MOBILEHOME SVC. BAR SINK GAR. SO. FT. ® POWER OUTLET ROOF DRAINS HEATING (FINAL) OTHER APPJEOUIP. DRAINAGE PIPING CAR P. I SQ. FT. ® TEMP. POLE WALL SO. FT. ® GROUT DRINKING FOUNTAIN SQ. 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 WASHER(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, TEM/PERM LAVATORY HEATING SYSTEM FORCED GRAVITY AMPERES SERV ENT SHOWER BOILER B.T.U. SO. FT. ® c BATH TUB GAR. FIREWALL SO. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SQ. FT. RESID ® 11/4 c SEWAGE DISPOSAL MESH SO.FT.GAR ® 3/ac HOUSE SEWER 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 APPJEOUIP. 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 INSULATION/SOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL /L INSPECTOR'S SIGNATURESIINITIALS_ GARDEN WALL FINAL