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04609 (AR)=r Y - 04609 P.O. BOX 1504 Building 78-105 CALLE ESTADO Address 77-625 Hildago .LA QUINTA., CALIFORNIA 92253 Owner atc hae1 dead am mailing Address sage ' City Zip Tel. - La Qi',inta 92253 Contractor State Lic.I City & Classif. Lic. # Arch., Engr., Designer Address Tel. CityI Zip I 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 I hereby affirm.that lam 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, -'akar, timprove, 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 the provisions. of. the"Contractor's License Law, Chapter (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, 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.) O I, 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= contr`acts 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 i:21/1" ," Owner 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 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 Lav s'iof California. 100EJb t J)J4V�. Date Owner iaJh NOTICE TO APPLICANT: Il, after making this Certificate of Exemptionyou 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. 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 it 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 BUILDING: TYPE CONST. OCC. GRP. P. Number Legal Description Project Description "And install Room +rid4ition,, PAU re—roof Sq. Ft. � Size No. Stories No. Dw. Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ it Estimated Valuation $100000 PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. �r Const. 0451i 804510 Mech. 22 ,I (it) Electrical 20.00 Plumbing S.M.I. 467 Grading Driveway Enc. Infrastructure TOTAL REMARKS ♦,rx {{ ,yY r �a�,�l!cc`))r Y s,,+' .:tsras� x rv�rya. .a :u..• v. 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 DATEINSrPECTOR Issued by: - Date Permit Validated by: Validation: 1 WHITE - FINANCE, PINK - APPLICANT, GREEN - BUILDING, GOLDENRQD - •SSESSOR'S OFFICE, HARD COPY - FILE CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES IST FL SO FT W s UNITS A.C. UNIT COLL. AREA SLAB GRADE YARD SPKLR SYSTEM 2ND FL SO FT. a HEATING (ROUGH) MOBILEHOME SVC. BAR SINK POR SO FT. a ROUGH WIRING POWER OUTLET ROOF DRAINS GAR SO. FT. a GAS (ROUGH) METER LOOP DRAINAGE PIPING CAR P. SO FT. Cr REINF. STEEL GAS (FINAL) WALL SO FT. a DRINKING FOUNTAIN URINAL SO. FT. a SERVICE ESTIMATED CONSTRUCTION VALUATION $ FINAL INSP. WATER PIPING NOTE: Not to be used as property tax valuation WATER SYSTEM FLOOR DRAIN MECHANICAL FEES E WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTONDISHI APPLIANCE DRYER FINAL INSP. GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED S LAUNDRYTRAY AIR HANDLING UNIT CFM REMARKS: 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. SO. FT. @ c BATH TUB SO. FT. @ c WATER HEATER MAX. HEATER OUTPUT. B.T.U. SO. FT. RESID a 1 V. c SEWAGE DISPOSAL SO.FT.GAR a 3/� c HOUSE SEWER GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEE MECH.FEE 11L.CK.FEE CONST. FEE ELECT. FEE SMI FEE PLUMB FEE STRUCTURE PLUMBING ELECTRICAL HEATING 8 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.IEOUIP. REINF. STEEL GAS (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM E GRADING cu. yd. plus xS =S LUMBER GR. L INSP. S FRAMING — / — j FINAL INSP. ROOFING �� S REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH ZSULATIONISOUND3 FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL r DESERT SANDS UNIFIED SCHOOL DISTRICT 82-879 Hi g bway 111 � ,�� p�T tl�,a;•o, cA 9zzo1 NOTICE: Dup CERTIFICATE OF SCHOOL FACILITY FEE WAIVER TO: This is to c rti fy that developer of w 'ch is located at /� Q/.�-� within this school district, is not req.' ed to pay school facility fe s pursuant to the authority generated by Government Code Section 53080. Building permits for the project indicated above may now be issued by your jurir5d.i,cti,00.wJlF VALUATION INDICATED" BUILDING PE IT UCEEDS�$20,000, ' THIS WAIVER IS VOID AND A SCHOO CIS I -IES-FEE, SAID-PRIOR-TO._.z ISSUANCE OF BUILDING PERMIT..""'' �f0 DESERT SANDS UNIF ED SCHOOL DI TRICT r White -Building Department Yellow -Facilities Planning Pink -Developer (10)-38