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002587 (BLCK)44 P.O. BOX 1504 No. 00 87 Buildingr5""7 cz 78-105 CALLE ESTADO Address LA QUINTA, CALIFORNIA 92253 Owner Dimim Mailing BUILDING:. TYPE CONST. OCC: GRP. Address Sam A.P. Number City ZipTel. �" ?' 1.La . Legal Description Contractor Project Description • .Address. .. .. .. .. City Zip . Tela •. State Lic. City & Classif, Lic. # Sq. Ft. No. No. Dw. Arch., Engr:, .. .. .. .. Size • • Stories Units Designer New Clk Add ❑ Alter ❑ Repair❑ Demolition ❑ Address Tel. City Zip State 96 Ups ft. of 6-�fOdt: �3� blo& _ Lic. # tt __..,... ��,��.,,�,. q �� LICENSED CONTRACTOR'S"DECLARATION _ UO "X• ft*'* � 6-hiiah dhain - 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 Fs effect. SIGNATURE DATE OWNER -BUILDER DECLARATION Estimated Valuation I hereby 'affirm that I am exempt from the Contractor's License Law for'the following 6��tF3� fV reason: (Sec, 7031.5,Business and Professions Code: 'Any city_or county which requires a ' permit to construct, alter,- Improve, demolish, or repair any structure, prior -to its issuance also - rn 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 3 of the Business and Professions Code, or.that.he is exempt'ttierefrom, and the basis' - - - for. the alleged exemption. Any violation of Section 7031.5 by 'any applicant -for a permit P.Ian.Chk. Dep..: 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 Plan; Chk. Bal. 2XM..2.5.02 do the work, and the structure is not intended or offered for sale. (Sec. 7044, Bulsness and CO�St. Professions Code: The Contractor's License. Law does not apply to an owner of property. who 38.50. 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 hedid not build or improve for the purpose, of sale.) O 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.I. • - ,• —such projects with -a contractor(s) licensed pursuant to the Contractor's License Law.) Grading 0.1 am exempt under Sec..B. B. & P.C. for this -reason - r _ Driveway Enc. Date. a-^ Owner t- �_ `� Infrastructure WORKERS' COMPENSATION DECLARATION 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. TOTAL 64A2 ,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 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 of Exemption you should become -ZONE: BY: - subject to 'the Workers" Compensation provisions 'of the Labor Code;you must foithwith Minimum Setback Distances:' comply with such provisions or this permit shall be deemed revoked. Front Setback.frorl..Center Line • Rear Setback frorr 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, Civil Code.) Side Setback frOfTh Property Line Lender's Name Lender's Address This is a building'permit when property filled out, signed and' validated, and'is subject to FINAL DATE INSPECTOR 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. Issued -by: Date Permit 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 purposesr•- r Validated by: Signature of applicant' at :'� �l a% \w _ _ Date Mailing Address A- - " `� Validation: City, State, Zip A6388 9 24 64,62 Ch HARD COPY CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SQ. FT. ® $ 2ND FL. SQ. FT. POR. SQ. FT. ® GAR. SO. FT. ® CAR P. SQ. FT. WALL SQ. FT. ® SQ. FT. ® ESTIMATED CONSTRUCTION VALUATION $ UNITS MOBILEHOME SVC. POWER OUTLET YARD SPKLR SYSTEM BAR SINK ROOF DRAINS DRAINAGE PIPING DRINKING FOUNTAIN URINAL WATER PIPING NOTE: Not to be used as property tax valuation BONDING FLOOR DRAIN MECHANICAL FEES FORMS WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER GAS (ROUGH) GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED OTHER APPIEOUIP. LAUNDRY TRAY AIR HANDLING UNIT CFM TEMP. POLE 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 SQ. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SQ. FT. RESID ® 11/4 c SEWAGE DISPOSAL y G SQ.FT.GAR ® 3/ac HOUSE SEWER VENTILATION�� 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 APPIEOUIP. EINF. 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 y G REMARKS: VENTILATION�� FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSU LATIONISOUN D FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INbFLL;I UK'b WUNA 1 UNtb11NI I IALb. GARDEN WALL FINAL