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002933 (BLCK)Building 53--523. JW Address Owner Mailing Address City La.. t?w , Contractor Address...,. City State Lic. & Classif: i - Arch., Engr., - Designer Address Zip 92253 Zip Tel.. City Lic. # Tel. � I P.O. BOX 1504 78-105 CALLE ESTADO . LA QUINTA, CALIFORNIA 92253 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: No. 092933 BUILDING: TYPE CONST. OCC: GRP. A.P. Number 774-125-002. ' Legal Description Project Description vfth a. _ .r planted s a of f1i3 i Sq. Ft. No. No. Dw. Size • Stories Units New p Add ❑ Alter ❑ Repair ❑ Demolition ❑ SIGNATURE DATE , OWNER -BUILDER DECLARATION I hereby affirm that 1 am 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, 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 Estimated Valuation w.�j •�7' PERMIT 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. De p• - 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. Plan Chk. Bal. COf1St. - 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 ❑ 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 contracts for S.M.I.. ' such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) - ❑ I am exempt under Sec. B. & P.C. for this reason Grading Driveway Enc. Side Setback from Property Line Date " Owner % ' = Infrastructure Lender's Address FINAL DATE 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.) expiration if work thereunder is suspended for 180 days.q Policy No. Company �' 7-8 ` ❑ Copy is filed with the city. ❑ Certified copy is hereby furnished. Issued by: TOTAL agree to comply with all city and county ordinances and state laws relating building CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE REMARKS construction, and herebyjauthorize representatives of this city to 'enter the above-. (This section need not be completed if the permit is for one hundred dollars ($100) valuation .,.ss.) mentioned property for inspection purposes. { I certify that in the performance of thg work for which this permit is issued, 1 shall not ' • -employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. AMOUNT GV�VV .50 MV Y sV Dale Owner NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become ZONE: BY: subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply 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 for which this permit is issued. (Sec_. 3097, Civil Code.) Side Setback from Property Line Lender's 'Nam Lender's Address FINAL DATE INSPECTOR 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.q �' 7-8 ` I certify that I have read this application and state that the above information is correct. 'to Issued by: Date t Permit agree to comply with all city and county ordinances and state laws relating building construction, and herebyjauthorize representatives of this city to 'enter the above-. mentioned property for inspection purposes. { Validated by: Signature of applicant ✓ . Date _. Mailing Address r Validation: City, State, Zip A 7 3 3 6 2 17 2u,56 R HARD COPY CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SO. FT. ® $ UNITS STORAGE TANK DUCT WORK YARD SPKLR SYSTEM 2ND FL. SO. FT. ® HEATING (FINAL) OTHER APP.IEQUIP. MOBILEHOME SVC. BAR SINK POR. SQ. FT. ® FINAL INSP. GAR. SO. FT. ® POWER OUTLET ROOF DRAINS, REMARKS: DRAINAGE PIPING CAR P. I SQ. FT. ® WALL SO. FT. ® DRINKING FOUNTAIN SQ. FT. ® URINAL ESTIMATED CONSTRUCTION VALUATION $ WATER PIPING NOTE: Not to be used as property tax valuation 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 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. SQ. FT. ® c BATH TUB SQ. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 11/4 c SEWAGE DISPOSAL SQ.FT.GAR ® 3/ac 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 HEATING & AIR COND. SOLAR A.C. UNIT COLL. AREA HEATING (ROUGH) STORAGE TANK DUCT WORK ROCK STORAGE HEATING (FINAL) OTHER APP.IEQUIP. FINAL INSP. GRADING cu. yd. $ plus x$ _ $ REMARKS: e!oTs z �3 �3�a� lo Lk 2.2. lb Uva e �......_�.-- .5O.f.)a CG►YJln & fat La, OVIO `a 8k zo Ave *i l do VeIasGa Yc r e e i'1 so q can — /,90/ JSi7.e APPROVED BY PIUim.oZA,.-j- !� \`esu, /lka�:�£ :SG✓���.ti.i....:� %NS.�rc.�c�n% �i`' j>L4.rN•"�CY' �✓GViS•/�"� _ . Asp— Pl/a — 4— _ 7 %? L, 5anchitaed P o . 'Coy 1240 /O © _L/E,! ;�A , CG%,C yzz..73 �� • 1 �8 Lime lac st s 3� 1/v6 ro�h. -Drip Avoier CO"Yra11 c.� .b 1? -6/3 . go I/ l v'G Yc r e e i'1 so q can — /,90/ JSi7.e APPROVED BY PIUim.oZA,.-j- !� \`esu, /lka�:�£ :SG✓���.ti.i....:� %NS.�rc.�c�n% �i`' j>L4.rN•"�CY' �✓GViS•/�"� _ . Asp— Pl/a — 4— _ 7 %? L, 5anchitaed P o . 'Coy 1240 /O © _L/E,! ;�A , CG%,C yzz..73 rM a mo To= awi ld;oqo) O:.r7• �roo": Pl��+MINI• �iviiiOq D, to : lr y�J� % s✓ bt : l.aA wsc*Pi'.40) Ravi rw 1404- fus i ait•lc. c oze JL 0 lGclurtss SlSE&4Hoa�.�