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002858 (3&4)P.O. BOX 1504 Building 78-105 CALLE ESTADO Address 55. 441 rime LA QUINTA, CALIFORNIA 92253 j Mailing ' Address 75-005 OMMtry ClUb Drive CityZip Tel. val`ii 92268 568;--282S.. - Contractor . . MtkMl 1brtqaM and Land . Address No. .002858 BUILDING: TYPE CONST. OCC. GRP. A.P. Number. Legal Description Project Description PM IW PRAM 14 $ Plsn 49 OR Date 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.) I Policy No. Company ❑ Copy is filed with the city. ❑ Certified copy is hereby furnished. f _ CERTIFICATE OF EXEMPTION FROM WORKERS' CE (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 tha 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, alter 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. 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 the above- mentioned property for inspection purposes., Signature ofapplicant4+ ��-%/..�'•��?'+ Date - Mailing Address City, State, Zip ti 1 HARD COPY In rastructure z.QQo•%M TOTAL REMARKS ZONE: BY: Minimum Setback Distances: ' City' Sam Zip Tel. Rear Setback from Rear Prop. Line State Lic. & Classif.28�� City Lic. # 328 DIM 3142 Sq. Ft. 5$9 Size No. No. Dw. Stories Units ' Arch., Engr., - Designer New 0. Add ❑ Alter ❑ Repair ❑ Demolition ❑ j Address Tel. Validation: City _ Zip State Lic. # LICENSED CONTRACTOR'S DECLARATIQN_, 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. 'V/ / x 1i l�% r�-•a /��Z ,�% ,— •, _ , SIGNATURE AA y _ _ DATE � OWNER -BUILDER DECLARATION I hereby:afh m 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, after, 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 o/ the Contractor's License Law, Chapter 9 (commencing with Section 7000) of the 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 /or 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 of property who '. i builds of improves thereon and who does such work himself or through his own employees, provided that, such improvements are not intended or offered /or sale. I/, however, the building or improvement is sold within one year o/ completion, the owner -builder will have the burden oI proving that he did not build or improve for the purpose of sale.) ❑ I, as owner of the property, am exclusively contracting with licensed contractors to con- strucl the project. (Sec: 704.4, 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 Estimated Valuation $ 2I5r834.00 - PERMIT - _i� Plan, Chk. Dep. Plan Chk. Ba.. AAl 3•4 COf1St. R�7G3•VU f Mech. S �{� •c Electrical +• ��•P5 Plumbing'' .40.50 S.M.I. - �C •�f Grading Driveway Enc. f Date 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.) I Policy No. Company ❑ Copy is filed with the city. ❑ Certified copy is hereby furnished. f _ CERTIFICATE OF EXEMPTION FROM WORKERS' CE (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 tha 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, alter 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. 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 the above- mentioned property for inspection purposes., Signature ofapplicant4+ ��-%/..�'•��?'+ Date - Mailing Address City, State, Zip ti 1 HARD COPY In rastructure z.QQo•%M TOTAL 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 1-27-87 Permit Validated by: Validation: A7214 1 30 x655,68 CP CONSTRUCTION ESTIMATE NO. ELECTRICAL F" "' NO. PLUMBING FEES 1ST FL. SQ. FT. ® UNITS SLAB GRADE 2 UGH PLUMB,(,"- BONDING YARD SPKLR SYSTEM 2ND FL. SQ. FT. ® FORMS EWER OR SEI qjt��j UGH WIRING Cl -d, (-W-? MOBILEHOME SVC. BAR SINK POR. SQ. FT. ® GAS (ROUGH) METER LOOP GAR. SO. FT. ® POWER OUTLET ROOF DRAINS GAS (FINAL) TEMP. POLE DRAINAGE PIPING CAR P. I SO. FT. ® GROUT WATER HEATER WALL SQ. FT. ® INSP. -4Q-q-'? DRINKING FOUNTAIN SQ. FT. ® WATER SYSTEM URINAL ESTIMATED CONSTRUCTION VALUATION $ =$ WATER PIPING NOTE: Not to be used as property tax valuation /y dRAMING Gj,7INAL FLOOR DRAIN MECHANICAL FEES 1 , Q, �1 ,✓ 06C T C �✓ !e /k f (� Q I WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED FIRE ZONE ROOFING LAUNDRY TRAY AIR HANDLING UNIT CFM FIREPLACE KITCHEN SINK ABSORPTION SYSTEM. B.T.U. TEMP USE PERMIT SVC WATER CLOSET COMPRESSOR HP POLE, TEM/PERM LAVATORY HEATING SYSTEM FORCED GRAVITY AMPERES SERV ENT SHOWER BOILER B.T.U. SO. FT. ® c BATH TUB MESH 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 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 /J ETBACK ROUND PLUMBI UNDERGROUND A.C. UNIT COLL. AREA SLAB GRADE 2 UGH PLUMB,(,"- BONDING HEATING (ROUGH) STORAGE TANK FORMS EWER OR SEI qjt��j UGH WIRING Cl -d, (-W-? DUCT WORK ROCK STORAGE A/0OUND. REINF. GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APP./EOUIP. d 6EINF. STEEL2 GAS (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE 1,eAINAL INSP. -4Q-q-'? BOND BEAM WATER SYSTEM 449INAL INSP. �.�lQ��' 7 $ GRADING cu. yd. plus x$ =$ LUMBER GR. /y dRAMING Gj,7INAL INSP. ��0� � OOF j S U' / 1 , Q, �1 ,✓ 06C T C �✓ !e /k f (� Q I REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR FIREWALL �,�//GAR. e49 ATHING MESH ez-4INSULATION/SOUN0q FINISH GRADING ,NAL INSPECTION ltd CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURES/INITIALS. GARDEN WALL FINAL