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13886 (RR)P.O. BOX 1504 NO.', x.3886 Building 49-185 Wa-shi'i1C ton - a$. 78-105 CALLE ESTADO �. Address LA QUINTA, CALIFORNIA 92253 a Owner b4i6p d Enter' ses W/® 'Ann- Tuty l6 , 'i•�,' BUILDING: -TYPE CONST. ' -A`- OCC: GRP. Mailing Address 'P ** O . BOX 88 A.P. Number City Zip ' Tel. La - Quina, .. 92253 - •554-�2i77 Legal Description Contractor • • ::etroof Cua�.Cfm RO©f$22C Comp3B'�i Project Description ' dggVo ch®'dos Co ate TeC: dio, 201 State L.tc ` City Lic. # o•alf -fa22 & ClassNo. Dw. Arch:,•Engr:` Size 3 Stories- Units • ' ' Designer New ❑ Add ❑ ' =-! Alter ❑' Repair ❑ '''Demolition.❑ r: Address Tel. ;s City ZipState s, • Lic. # c LICENSED CONTRACTOR'S DECLARATION I hereby affirm that l am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3,6f thb Business and Professions Code, and my license is in full force and,. •__" - I _ effect - #',i-•5•,F+G�`,r'� '6.✓`w'i"s� - - - , SI ✓e `: SIGNATURE -.4 .'" .✓ - DATE 'OWNER -BUILDER DECLARATION "Estimated Valuation �•'(;O 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 - Perm! to construct,- atter, improve, demolish, or repair any structure, l prior to.its issuance also- y ,� - requires the applicant for such'permitto 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 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. i subjects the applicant to a civil penalty of not more than live hundred dollars .($500). ❑ I, as owner of the property, or my employees with wages as their sole compensation, will Plan Chk..Bal. ' do the work, and the structure is not intended or offered for sale. (Seca 7044, Buisness andCOf1St: = 30. 00 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 offered for 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 - .} does not apply to an owner of property who builds or improves thereon, and who contracts for .' .S, M. 1. - such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) } x ❑ I am exempt under Sec. ` B. t1 P.C. for this reason Grading Driveway Enc. Date owner Infrastructure ?:.j }x WORKERS' COMPENSATION DECLARATION r I hereby'affirm-that l have a certificate of consent to self -insure, or a certificate of y Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.) Policy No -w"' : •:. Company . 951C_py is filed with the city: ❑ Certified copy is hereby furnished. r all AM TOTAL - CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE REMARKS-_ (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 t NOTICE TO APPLICANT: If, alter making this Certificate of Exemption you should become . - ZONE: - � $Y. } 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: • M " ' ,� r1 �•. - Front Setback from'Center Line Rear Setback from Rear Prop. Line A CONSTRUCTION LENDING AGENCY' Side Street Setback from Center Line I hereby affirm that there is a construction lending agency for the:performance of the v r� r work for which this permit is issued. (Seca 3097, Civil Code .J { • Side Setback4rom Property Line: P Lender's Name t Lender's Address This is a.building when filled out, signed and validated, and issubject to FINAL DATE INSPECTOR permit properly 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: y ly Date -j, "-• Permit a 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.. y#, mentioned property for inspection purposes. 2 %Qn jj(j Validated by: a Signature of applicant Date r/ d _ Mailing Address - Validation: City, State, Zip t; CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SO. FT. p $ UNITS SLAB GRADE 0 � � BONDING HEATING (ROUGH) 2ND FL. SO. FT. Q FORMS YARD SPKLR SYSTEM POR. SO. FT. ® MOBILEHOME SVC. BAR SINK GAR. SO. FT. ® POWER OUTLET ROOF DRAINS HEATING (FINAL) OTHER APPJEOUIP. DRAINAGE PIPING CAR P. SO. FT. TEMP. POLE WALL SO. 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 WASHER(AUTO)(DISH) APPLIANCE DRYER GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED LAUNDRYTRAY AIR HANDLING UNIT CFM VENTILATION 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. SO. FT. RESID ® 11/4 c SEWAGE DISPOSAL SO.FT.GAR ® 3/ac HOUSE SEWER GAS PIPING PERMIT FEE FEE PERMIT FEE DBL —[—PERMIT 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 ROCKSTORAGE 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 27/.� 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