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002869 (3&4)P.O. BOX 1504 Building 78-105 CALLE ESTADO Address 5"'191 FiresttDw LA QUINTA, CALIFORNIA 92253 Owner Mailing AMOUNT Address BY: City � Zip Tel. 1,2111M � . 922W 588-8828 . Contractor 55.00 p and ..Address . SAM Plumbing -Zip City Sam S.M.I. Tel. " State Lic. Issued by: City & Classif. 28sm Lic. # 328 Arch., Engr., i Designer j. A71`J8 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. .%rV tri ; L:f'r �c:+jl :y- •. SIGNATURE - DATE OWNER -BUILDER DECLARATION I hereby affirm that I 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 forsuch 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- Busines-s 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 rive 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 or 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 or sale.) .. ❑ 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 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 No. 002869 BUILDING: -TYPE CONST. OCC. GRP. A.P. Number Legal Description Project Description PlA PFM 14 $ PIM 30 Qr- " Sq. Ft. EIM 2825 No. No. DIN. Size ""GM 5$8 Stories •• Units New Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation ��ee 194.692..00 . S ,.. PERMIT AMOUNT Plan Chk. Dep. = BY: Plan Chk. Bal. 555.10 Const. 671.50 Mech. 55.00 Electrical 121,71 Plumbing M.50, S.M.I. FINAL DATE Grading Issued by: Driveway Enc. Validated by: 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, or a certified copy thereof. (Sec. 3800, Labor Code.) Policy No. • Company ❑ Copy is filed with the city. O 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 Laws of California. Date Owner NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become - subject "to the Workers' Compensation provisions or 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 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 they above- mentioned property for inspection purposes. f w Signature of applicant 1 ' } t ti� -f + -i Date _ �' 4 Mailing Address `" J City, State, Zip HARD COPY TOTAL REMARKS w©0 1 ZONE: BY: Minimum Setback Distances: f 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 1-27—R7 Permit Validated by: Validation: A71`J8 1 30 ."555.243 Ch CONSTRUCTION ESTIMATE ANIL NO. ELECTRICAL FQIdk NO. PLUMBING FEES 1ST FL. SO. FT. ® $ UNITS COLL. AREA .C,4—"SLAB GRADE_7—/� r) ROUGH PLUMB. j YARD SPKLR SYSTEM 2ND FL. SO. FT. HEATING (ROUGH) STORAGE TANK POR. SO. FT. ® MOBILEHOME SVC. BAR SINK GAR. SO. FT. ® POWER OUTLET ROOF DRAINS FOUND. REINF. GAS (ROUGH) DRAINAGE PIPING CAR P. SO. FT. ® HEATING (FINAL) OTHER APP.IEOUIP. WALL SO. FT. GAS (FINAL) DRINKING FOUNTAIN SO. FT. ® URINAL ESTIMATED CONSTRUCTION VALUATION $ WATER HEATER WATER PIPING NOTE: Not to be used as property tax valuation /61NAL INSP. t FLOOR DRAIN MECHANICAL FEES WATER SYSTEM WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED /jkfINAL INSP. LAUNDRYTRAY AIR HANDLING UNIT CFM ��IG 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 ® 1114 c SEWAGE DISPOSAL SO.FT.GAR ® 3/4c HOUSE SEWER CATHING 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 t-11— SETBACK J, S� 40UND PLUM % UNDERGROUND A.C. UNIT COLL. AREA .C,4—"SLAB GRADE_7—/� r) ROUGH PLUMB. j BONDING HEATING (ROUGH) STORAGE TANK FORMS (SEWER OR SEE K!) d L�6UGHWIRIN DUCT WORK ROCK STORAGE FOUND. REINF. GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APP.IEOUIP. �REINF. STEEL 3''L/ — GAS (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE /61NAL INSP. t BOND BEAM WATER SYSTEM GRADING cu. yd. $ plus x$ -$ LUMBER GR. 16INAL INSP. O FRAMING Z �' /jkfINAL INSP. �� fir% !Zr,L ��IG ` v1/ �a �GZr �2% P% REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL CATHING MESH % INSULATION/SOUND FINISH GRADING /� INAL INSPECTION ✓) 311 S7 CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURES/INITIALS GARDEN WALL FINAL