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10963 (RER)4 P.O. BOX 1504 C �� No. 10963 Building r ,r. 78-105 CALLE ESTADO ;'1 l Address 65 Eisenh©,aer Drive LA QUINTA, CALIFORNIA 92253 Owner ! / George E. Anderholt Mailing BUILDING: TYPE CONST. OCC: GRP. Address 1481 -Opuntia Rd � A.P. Number City Zip Tel. � atm SP4 92262 Legal Description Co actor Project Description UPactor%BUi. dCix 1 P Address . Repair Garage Damage City Zip Tel.: 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 I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section j 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 400 reason: (Sec. 7031.5,8usiness and Pro/essions Code: Any city or county which requires a, t permit to construct, alter, Improve, demolish. or repair any structure, prior to its issuance also requires the applicant for such permit to Ile 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 Mat. 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 rive 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. j J 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 conptetion, the owner -builder will have the burden Electrical Of proving that he did not build or improve for the purpose of sale.) 01' 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; . i such projects with a contractor(s) licensed pursuant to the Contractors License.Law.) Grading O I am exempt under Sec R, & P.C. for this reason Driveway Enc. Date Own el g % C" g Infrastructure I I, 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. Cl Certified copy is hereby furnished. - r.^• ^" * ^^ ^ TOTAL Tits;s%� i t � rpt x t 3. . OV, CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars .(5100) valuation or less.) I certify that in the perfomrance 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 Ownet NOTICE TO APPLICANT: 8, jotter 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 shag 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, Chd Code.) Lender's Name Lender's Address This is a building permit when property 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 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 Permit Validated by: Validation: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES IST FL. SQ. FT. ® $ UNITS COLL. AREA SLAB GRADE YARD SPKLR SYSTEM 2ND FL SQ. FT. HEATING (ROUGH) STORAGE TANK FORMS MOBILEHOME SVC. BAR SINK POR. SQ. FT. ® DUCT WORK ROCK STORAGE GAR. SQ. FT. ® POWER OUTLET ROOF DRAINS CAR P. SQ. FT. HEATING (FINAL) DRAINAGE PIPING WALL SQ. FT. DRINKING FOUNTAIN. SQ FT ® 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 GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED ROOFING LAUNDRYTRAY 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. SO. FT. ® c BATH TUB SO. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 1% c SEWAGE DISPOSAL GAR. FIREWALL on SQ.FT.GAR ® 3Ac HOUSE SEWER LATHING 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 L - « HEATING (ROUGH) STORAGE TANK FORMS SEWER OR SEPTIC TANK ROUGH WIRING, DUCT WORK ROCK STORAGE FOUND. REINF. GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APPJEQUIP. REINF. STEEL GAS (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM FINAL INSP. GRADING cu. yd. $ -Plus-x$-=$ LUMBER GR. FRAMING d 1 v FINAL INSP. ROOFING REMARKS: VENTILATION FIRE ZONE ROOFING ' FIREPLACE SPARK ARRESTOR GAR. FIREWALL on LATHING MESH INSULATION/SOUND FINISH GRADING NSPECTION FINAL INSPECTION- cCCCC s` CERT. CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESlINMALS GARDEN WALL FINAL