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002508 (BLCK)P.O. BOX 1504 N o ,. Building 78-105 CALLE ESTADO Address 51-296 • Gt=,W=1a LA QUINTA, CALIFORNIA 92253 i Mailing i Address 51-296 ( Giatemou i .. CityZip Tel. %i Quin to 92253 i Contractor Address City ... lZip . ITel. _ State Lic. I City & Classif. Lic. # Arch., Engr., Designer Address - Tel. City Zip State j . 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 I hereby affirm that I am exempt from the Contractors License Law for the following. _ reason: (Sec.. 7031.5,Business and Professions Code: Any city or county_ which requires a • permit to construct, atter, 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 i 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 subjects the applicant'to a civil penalty of not more than five hundred dollars ($500). I ❑ 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 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 . 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.) . ❑ 1, 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 property who builds .or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) ❑ 1 am exempt under Sec. B. & P.C. for this reason - Date Owner V .rw - 1� 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 ❑ Copy is filed with the city. . ❑ Certified copy is hereby furnished. - CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars ($100) valuation or less.) - I certify that in the performance of thg work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. 'Date Owner M . NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. I CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code.) Lender's Name Lender's Address This is a building permit when properly filled out, signed and validated, and is subject to expiration if work thereunder is suspended for 180 days. I certify that I have read this application and state that the above information is correct. I agree to comply with -'all city and county ordinances and state laws relating to building construction, and hereby authorize representatives -of this city to enter the above- mentioned property for inspection purposes. Signature of applicant �� Date Mailing Address City, State, Zip HARD COPY BUILDING: TYPE -CONST. OCC: GRP. A.P. Number Legal Description Project Description 6—fwt hii block wall' Sq. Ft. No. No. Dw. Size 97 11n.-f$Stories Units New Add ❑ Alter ❑. Repair ❑. Demolition ❑ Estimated Valuation fi ? A7q_1"tt'11 PERMIT AMOUNT Plan Chk. Dep. . Plan Chk: Bal. 25.02 Const. 33.58 Mech. Electrical Plumbing INSPECTOR S.M.I. R50 Grading Driveway Enc. Validation. Infrastructure A6123 8 1 64,b2 CC TOTAL 64.82 REMARKS ZONE: 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 7-•29" 86Permit Validated by: Validation. A6123 8 1 64,b2 CC CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SO. FT. ® $ UNITS COLL. AREA SLAB GRADE ROUGH PLUMB. YARD SPKLR SYSTEM 2ND FL. SO. FT. ® HEATING (ROUGH) STORAGE TANK FORMS MOBILEHOME SVC. BAR SINK POR. SQ. FT. ® DUCT WORK ROCK STORAGE GAR. SQ. FT. ® POWER OUTLET ROOF DRAINS METER LOOP HEATING (FINAL) DRAINAGE PIPING CAR P. Q. FT. ® GAS (FINAL) WALL SO. FT. ® DRINKING FOUNTAIN SQ. FT. ® WATER HEATER URINAL ESTIMATED CONSTRUCTION VALUATION $ FINAL INSP. WATER PIPING NOTE: Not to be used as property tax valuation WATER SYSTEM FLOOR DRAIN MECHANICAL FEES GRADING cu. yd. $ plus x$ WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASH ER(AUTO)(DISH) APPLIANCE DRYER FINAL INSP. GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED X T i%�-D/���//�/ EX % LAUNDRY TRAY AIR HANDLING UNIT CFM REMARKS: 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. SQ. FT. ® c BATH TUB SQ. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SQ. FT. RESID ® 1+/a c SEWAGE DISPOSAL SQ.FT.GAR ® 3/ac HOUSE SEWER MESH 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 )j/(!�FOUND. REINF. �� - GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APP./EQUIP. 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 X T i%�-D/���//�/ EX % 'J / REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING' MESH INSULATION/SOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS, GARDEN WALL FINAL vol 50 e -n �C/ 4 RQ/ �cr-c�� "