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06081 (BLCK)• I 4 P.O. BOX 1504 No. 06-081 Buildingi 7&105 CALLE ESTADO Address 54"015 ' `f errera LA QUINTA, CALIFORNIA 92253 Owner Jack UaTk, Jr. BUILDING: -TYPE CONST. OCC: GRP. Mailing - Address P. 0. Box 1371 A.P. Number 774-21-1-015 City Zip Tel. La quiuta • 192253 Legal Description Contractor Project Description 901 X 2h' of Xetainitg wail Address City Zip Tela State Lic. City & Classif. Lic. # Sq. Ft. No. No. Dw. Arch., Engr., Size Stories Units • � ' Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Address Tel. City Zip State Lic. # LICENSED CONTRACTOR'S DECLARATION hereby affirm that I am licensed under provisions Of Chapter 9 (commencing with Section 7000) of Division 3 of the Busine7 and ProfetponsfiCode, and my license is in furl fo cd a f ", f✓�`.i 'l•y SIGNATURE DATE r , .1 - OWNER -BUILDER DECLARATION Estimated Valuation I hereby affirm that I am exempt from the Contractor's License Law for the following $1,350 reason: (Sec. 7031.5,8usiress and Professions Code: Any city or county which requires a permit to constrict, after, improve, demolish, or repair any structure, prior to its issuance also requires the applicant for such permit to fife 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 Dhis on 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. subjects the apprroant to a civil penalty of not more than rive hundred dollars (x500). plan Chk. Bal. ❑ 1, 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 Const.Ih�J •�1k1 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-bufider wi8 have the burden Electrical of proving that he did not butt or improve for the purpose or 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.I. such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) Grading ❑ 1 am exempt under Sec B. & P.C. for this reason Driveway Enc. Date owner Infrastructure WORKERS' COMPENSATION DECLARATION 1 hereby affirm that I have a certificate of consegt=to self -insure, or a certificate of Workers Compensation Insurance, or a certif�eopy tth feof. (Sec. 3800, Labor Code.) Policy No Company ❑ Copy is filed with the city. ❑ Certified copy is hereby furnished. TOTAL $: •14 CERTIFICATE OF EXEMPTION FROM REMARKS WORKERS' COMPENSATION INSURANCE (This section need not be completed ff the pemdt is for one hundred dollars ($100) valuation .(ki ,�,F': ,'? •i , i s.�+,aY-• :e •a `i .'"'iaiT �r�. • 'r, or fess.) .i it {.1794 Y r .7i .? r.1 Y / Y,y, .w - .• v 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 aliforniaDateOwner NOTICE TO APPLICANT: ff. after making this Certificate of Exemption you should become ZONE: BY: subject to the Workers' Compensation provisions of the Labor Code, you must forthwith coney with such provisions or this permit shall be deemed revoked. Minimum Setback Distances: Front Setback from Center Line Rear Setback from 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 forwhich this permit is issued. (Sec. 3097, ChdCode.) Side Setback from Property Line Lenders Name Lenders Address FINAL DATE INSPECTOR This is a building permit when properly filled out, signed and validated, and is subject to expiration it work thereunder is suspended for 180 days. //u/89 jt,/ 89 I certify that I have read this application and state that the above information is correct. Issued by: Date Permit 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. Validated by: Signature of applicant Date Mailing Address Validation: City, State, Zip CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES IST FL. SO. FT. ® $ UNITS SLAB GRADE ROUGH PLUMB. BONDING YARD SPKLR SYSTEM 2ND FL SO. FT. @ FORMS SEWER OR SEPTIC TANK ROUGH WIRING MOBILEHOME SVC. BAR SINK POR. gp, FT, ® GAS (ROUGH) METER LOOP GAR. Sp. FT, ® POWER OUTLET ROOF DRAINS GAS (FINAL) TEMP. POLE DRAINAGE PIPING CAR P. I SO. FT. ® I WATER HEATER WALL SO. FT. FINAL INSP. DRINKING FOUNTAIN. SO FT @ WATER SYSTEM URINAL ESTIMATED CONSTRUCTION VALUATION $ WATER PIPING NOTE: Not to be used as property lax valuation FINAL INSP. 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 LAUNDRY TRAY AIR HANDLING UNIT CFM FIRE ZONE ROOFING 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 LATHING SO. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® IV4 c SEWAGE DISPOSAL SO.FT.GAR ® V4c HOUSE SEWER 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 APPIEQUIP. EINF. STEEL/,3�� GAS (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. t4BOND BEAM 7 �/ 7 - p WATER SYSTEM GRADING cu. yd. $ -Plus-x$-=$ LUMBER GR. FINAL INSP. FRAMING FINAL INSP. ROOFING 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 k