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002960 (PLBG)17lri. 19©03, La n,.Inta � P.O. BOX 1504 No. 002960 Building Tr. 78-105 CALLE ESTADO Address9"� LA QUINTA, CALIFORNIA 92253 Owner 'i fteriCM Drad qtr MW. BUILDING: TYPE CONST. OCC: GRP. Mailing Address .orars we wt c c, A.P. Number City Zip Tel. Placentia CA. 02607 (-Ili � 996•2CO(} Legal Description ) Gm Idna Contractor Project Description 9C� �� '� Gam Plumbing. Address 38-575 T"3 xtos City Zip Tel.'' Benmida Dunes 92201 345-3774 State Lic. City & Classif. 335702 Lic. # 706 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 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 permit to construct, alter, improve, demolish, or repair any structure, prior -to its issuance also AMOUNT requires the applicant. for such permit to file a signed statement that he is licensed pursuant to PERMIT - the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of t.� "Division 3 of the Business and Professions Code, or that. he is exempt therefrom, and the* basis a - - • for the alleged exemption. Any violation of Section 7031.5 .by,'any, applicant' for.a permit - Plan 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. do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and Const."' 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 20.00 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 ❑ I am exempt. under Sec. B. & 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, or a certified copy thereof. (Sec. 3800, Labor Code.) Policy No. .Company O Copy is filed with the city.. O Certified copy is hereby furnished. TOTAL `y► ;eu.Cu 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 '�• r ;' t ' + ..1 - 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 .forthwith Minimum Setback Distances: comply with such provisions or this permit shall be deemed revoked. ' Front Setback•from Center Line Rear Setback from Rear Prop. Line jCONSTRUCTION LENDING AGENCY Side Street Setback from Center Line Ihereby 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 from Property Line Lender's Name .Lender's Address • This is a building permit when properly filled out, signed and validated, and is subject to FINAL DATE _ INSPECTOR expiration it work thereunder is suspended for 180 days./.�.9 r.7 I certify that I have read this application and state that the above information is -correct. Issued by: Date 11J Permit I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives sof this city to enter the above- mentioned property for inspection purposes. Validated by: Signature of applicant Date Mailing Address Validation: City, State, Zip HARD COPY T 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 ROUGH WIRING MOBILEHOME SVC. BAR SINK POR. SQ. FT. ® GAS (ROUGH) METER LOOP GAR. SQ. FT. ® POWER OUTLET ROOF DRAINS GAS (FINAL) TEMP. POLE DRAINAGE PIPING CAR P. SQ. FT. GROUT WATER HEATER WALL SQ. FT. FINAL INSP. DRINKING FOUNTAIN SO. FT. ® WATER SYSTEM URINAL ESTIMATED CONSTRUCTION VALUATION $ _$ WATER PIPING NOTE: Not to be used as property tax valuation FINAL INSP. FLOOR DRAIN MECHANICAL FEES WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER VENTILATION 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, 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 SQ.FT.GAR ® 3/.c HOUSE SEWER FINISH GRADING 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 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 y'f C ��� ' f ` REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATIONISOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURES/INITIALS GARDEN WALL FINAL