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13880 (RR)P.O. BOX 1504 (; No. -1.38'80- Building 49-065 Washington St* 78-105 CALLE ESTADO y Address LA QUINTA, CALIFORNIA 92253 Owner:- a iEnterprises c/o AnnTUT Mailing BUILDING: TYPE CONST: OCC: GRP.. y; Address A.P. Number City Zip JTel. La Qui.nta, ,. CA . 92253 _ ....564-2177 Legal Description Contractor • 6x0of Custom Roofing Company -,Project Description Ade .0 Rancho i4s Coyotes _ . t Cit = f. Iudio, .CA Zip 92201 Tel.: 3453751, Thereby affirm that Lhave a certificate of consent to self -insure, or a certificate of State Lic. & Classif. ' C ,'39.:625038 City Lic. # 12 Sq. Ft. • SizeStories 4 No� � •, No. Dw. ;1 Units �. --=-Arch: Engr-,..*-- •—.... , - - --..__ __._ - ' Designer New ❑ Add ❑ -J'- `Alter ❑ Repair ❑ Demolltlor ,'O • ; Address Tel. ~ CERTIFICATE OF EXEMPTION'FROM REMARKS WORKERS' COMPENSATION INSURANCE r v: . City, _ Zip State Lic. # ' or less.) ` LICENSED CONTRACTOR'S DECLARATION I hereby affirm that) 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{RE y s, w. I e + SIGNATURE DATE OWNER -BUILDER DECLARATION hereby affirlm 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 to permit construct, alter, improve, demolish, or repair. any structure, l 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, Chapter 9 (commencing with Section 7000) of• Di0sion' 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). 01,as owner of the property, or my employees with wages as their sole compensation, will ` Estimated Valuation' -:M780.00 - PERMIT - - ti '':. AMOUNT.,.. ' Plan Chk: Dep. •..� - Plan Chk. Bal. NOTICE TO APPLICANT: If, after making this Certificate or Exemption' you should become Const. �!• �� • r'•:: 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 Mech. 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.) Electrical Plumbing Rear Setback from Rear Prop. ❑ 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 propertywhobuilds'or improves thereon, and who contracts.for such projects with a contractors) licensed pursuant. to 4he•Contractor's License.Law:) • ._ - ❑.I am exempt under-Sec.B. 8 P.C. for this reason S. M. 1. ` +: Grading - -- - -Driveway Enc. Date owner Infrastructure • WORKERS' COMPENSATION DECLARATION Thereby affirm that Lhave a certificate of consent to self -insure, or a certificate of Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.) r� • ` ^ ' PolicYN'- Company QlCopy is filed'w_ with the city. ❑ Certified copy is hereby furnished. }; TOTAL. ~ CERTIFICATE OF EXEMPTION'FROM REMARKS WORKERS' COMPENSATION INSURANCE n' (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 or 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. CONSTRUCTION LENDING AGENCY, wLine Side Street Cente line hereby affirm that there is a construction lending agency for the performance of the for this is issued. work which permit (Sec. 3097, Civil Code.) - —Side Setbackfrom Property`Llne/ • Lender's Name Lender's Address�✓ FINAL DATE INSPECTOR" • 1 O 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. Issued by: € Date Pe mit -' I agree to comply with all city and county ordinances and state laws relating to building a - iy construction, and hereby authorize representatives of this city to. enter the above•. mentioned property for inspection purposes.' r Validated by: l / 'Signature applicant bate' k J Mailing Address ress - , Validation: - City, State, Zip, CONSTRUCTION ESTIMATE NO. t ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SO. FT. ® $ UNITS COLL. AREA SLAB GRADE ROUGH PLUMB. BONDING 2ND FL. SO. FT. @ YARD SPKLR SYSTEM POR. SO. FT. ® MOBILEHOME SVC. BAR SINK GAR. SO. FT. ® POWER OUTLET ROOF DRAINS CAR P. I SO. FT. GAS (ROUGH) DRAINAGE PIPING WALL SO. FT. ®' DRINKING FOUNTAIN. SO. FT. ® GAS (FINAL) URINAL ESTIMATED CONSTRUCTION VALUATION $ WATER PIPING NOTE: Not to be used as property tax valuation WATER HEATER FLOOR DRAIN MECHANICAL FEES WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED FINAL INSP. 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. SO. FT. ® c BATH TUB SO. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 11/4 c S SEWAGE DISPOSAL SPARK ARRESTOR SO.FT.GAR ® 3/ac HOUSE SEWER GAR. FIREWALL 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: REMARKS: VENTILATION FIRE ZONE ROOFING , FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATION/SOUND FINISH GRADING FINAL INSPECTION Q CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURES/INITIALS GARDEN WALL FINAL