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12107 (PLBG)Qulwra P.O. BOX 1504 NO. ICIV I Building78-105 CALLE ESTADO Address 54-605 iiorrera LA QUINTA, CALIFORNIA 92253 Owner Freddie Mac Mailing BUILDING: TYPE CONST. OCC. GRP. Address Pwo. Box 5000 A.P. Number City Zip Tel. Vienna, C Legal Description Contractor Project Description -Bawer Connect Address 73--110 Velardo City Zip Tel Palm Desert., a�. 9226f� 341-•9224 State.Lic. City & Classif. Lic. # S Ft. No. No. Dw. 3�i�� 2613 a• Size Stories Units Arch:, Engr., - Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Address Tel. - City JZip State Lic. # UCENSED dONfRACTOAS DECLARATION I,�Yeby afdiFfi" that I a�jn licked"under islgg�6 pte commencing with Section �e00e0); f fvisi� 3+obt a Bu I ess a 'Pro s o 5 o a. my icense is in full force and F /. i SIGNATURE '.Or Ir ,/ s J DATE . %_,- J./ ! OW ER -BUILDER DECLARATION Estimated Valuation I hereby affirm that I am exempt from the Contractor's License Law for the following $1,000.00 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 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 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 applicant to a civil penalty of not more than five hundred dollars ($500). ❑ 1, 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 30.00 struct the project. (Sec. 7044, Business and Professions Code: jThe 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.) Grading ❑ 1 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, of a certified copy thereof. (Sec. 3800, Labor Code.) Policy No. company—•i �: '� x k' '`0 ❑ Copy is filed with the city. ❑ Certified copy is hereby furnish e $ �"*'"�¢- x.r �•;-' TOTAL 30.00 CERTIFICATE OF EXEMPTION FROM REMARKS WORKERS' COMPENSATION INSURANC♦E (This section need not be completed.)/ the/becc�Je it is for hundred dollars ($100) valuation or less.) • ,/ . _ certify that in the per(o f thr wp�cecmit�s.issued I shall not employ aany pe4sd in n'y manner -s a sGbje t to•t a Work rs' C•nrfpensation h aws oQt; ifdrnia �` hr A NOTICE TOlAPPL'ICANT: lf,4aIf, iRb ifthisr Ce�ficAte ExemP_t0h 10if shouli subject to the Workers' Comp nsat' n' provisions of a Labor Code, you must - comply with such provisioasor�is pe it shall be deemed revoked. CONSTRUCTION LENDING AGENCY Ihereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code.) Lender's Name Lender's Address This is a building permit when properly filled out, signed and validated, and is subject to expiration if work thereunder is suspended for 180 days. I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives sof this city to enter the above-. mentioned property for inspection purposes. Signature of applicant Date Mailing Address City, State, Zip ZONE: BY: Minimum Setback Distances: Front Setback from Center Line Rear Setback from Rear Prop. Line Side Street Setback from Center Line Side Setback from Property Line FINAL DATE INSPECTOR Issued by: Date Permit Validated by: Validation: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLU68ING P$S 1ST FL. SO. FT. 0 $ UNITS COLL, AREA SLAB GRADE YARD SPKLR SYSTEM 2ND FL. SO. FT. @ HEATING (ROUGH) STORAGE TANK - FORMS MOBILEHOME SVC. BAR SINK POR. SO. FT. 0 DUCT WORK ROCK STORAGE GAR. SO. FT. 0 POWER OUTLET ROOF DRAINS METER LOOP HEATING (FINAL) DRAINAGE PIPING CAR P. SO. FT. 0 GAS (FINAL) WALL SO. FT. 0 DRINKING FOUNTAIN SO. FT. 0 URINAL ESTIMATED CONSTRUCTION VALUATION $ FINAL INSP. WATER PIPING NOTE: Not to be used as property tax valuation FLOOR DRAIN MECHANICAL FEES GRADING cu. yd. $ plus x$ WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER ROOFING GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED LAUNDRYTRAY AIR HANDLING UNIT CFM 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. 0 c BATH TUB SPARK ARRESTOR SO. FT. 0 c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID 0 11/4 c SEWAGE DISPOSAL LATHING SO.FT.GAR 0 3/ac HOUSE SEWER MESH GAS PIPING PERMIT FEE INSULATIONISOUND 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 OUGH WIRING DUCT WORK ROCK STORAGE FOUND. REINF. GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APP.IEOUIP. 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 REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATIONISOUND FINISH GRADING FINAL INSPECTION L J CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURES/INITIALS GARDEN WALL FINAL Received From:a Address: `tel` �d� ( f� 1' '✓L� y ��Ct !/ i Account No. �/ Lot(s) Service Address ❑ Meter(s) ❑ Service(s) ❑ Backflow(s) ❑ House Lateral(s) ❑ DetectorCheck(s) ❑ MMeterSurcharge c- VSanitation Capacity Charge C -ref 7, J • w SS ❑ W.S.B.F.C. ❑ Temporary Construction Meter ❑ Turn on Charge ❑ Uncollected Account - Name ❑ Inspection Fee - Tract - Fee - ❑ Plan Check Fees Water I Sewer - Tract - ❑ Bond Payment - A.D. - Bond Assmt. ❑ Customer Deposit ❑ Other G.A. Code TOTAL $ Water Service Cashier- Remarks: ❑Copy to: Cash Check , Money Order G.A. Code TOTAL $ Water Service Cashier-