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003042 (BLCK)Building Address Owner Mailing Address City Ld Ot Contractor .. Address City C_lkth ft State Lic. & Classif. Arch:, Engr., Designer T4'1�v 4 P.O. BOX 1504 No. 003042 78-105 CALLE ESTADO LA QUINTA, CALIFORNIA 92253 Zip ITel. 92253 '.x-050 Skv Blue Water Trall Zip Tela - .1t. 1 92236 324-5722 I Lic. # BUILDING: -TYPE CONST: - OCC. GRP. A.P. Number _ z�-- (1 �� — 007 Legal Description Project Description 252 of 41 and 21.Of 60" gall Sq. Ft. No. No. Dw. Size Stories Units New p 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 • 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 I hereby affirm that I am exempt from the Contractor's License Law for the following Estimated Valuation zn reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a s3ac?r!.} t .� 'PERMIT AMOUNT ' 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 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 Sectlon' 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).', O 1, as owner of the property, or my employees with wages as their sole compensation, will Plan Chk. Dep. Plan Chk. BBI. JA�• 3� COf1St. ,�' • 00. 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 Mech. . 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 Electrical . 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.) Plumbing O 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 S. M. 1. ' •s such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) qq, I am exempt under Sec. B. & P.C. for this reason N1 it ,r s=+ Grading Driveway Enc. Dto t �! • ✓%' Owner , - % ). o o t ft h..: r- _tetra Infrastructure WORKERS' COMPENSATION DECLARATION 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. . TOTAL $36.80 - CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE REMARKS (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 Laws of California. Date Owner ' 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. ZONE: BY: Minimum Setback Distances: ' Front Setback from Center Line Rear Setback from Rear Prop. Line colusrRucnoN LENDING AGENCY Side Street Setback from Center Line 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.) - Side Setback from Property Line 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. FINAL DATE INSPECTOR 4/10187 ' 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. Issued by: Date Permit Validated by: Signature of applicant Date Mailing Address Validation: A7724 4 10 3b80 11 T City, State, Zip HARD COPY CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SO. FT. ® $ UNITS SLAB GRADE ROUGH PLUMB. BONDING YARD SPKLR SYSTEM 2ND FL. S0. FT. FORMS SEWER OR SEPTIC TANK ROUGH WIRING MOBILEHOME SVC. BAR SINK POR. SQ. FT. ® GAS (ROUGH) METER LOOP GAR. SO. FT. ® POWER OUTLET ROOF DRAINS S (FINAL) TEMP. POLE DRAINAGE PIPING CAR P. SQ. FT. GROUT WATER HEATER WALL SQ. FT. FINAL INSP. DRINKING FOUNTAIN SQ. FT. ® WATER SYSTEM 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 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, TEMIPERM 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. SQ. FT. RESID ® 11/4 c SEWAGE DISPOSAL SQ.FT.GAR ® 3/ac HOUSE SEWER FINISH GRADING 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 APPJEQUIP. REINF. STEEL L� / S (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. n �4610ND BEAM L�� f WATER SYSTEM GRADING cu. yd. $ -Plus-X$-=$ LUMBER GR. FINAL INSP. FRAMING FINAL INSP. ROOFING � pC d �7 1 '••r REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATION/SOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURES/INITIALS GARDEN WALL FINAL