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09348 (PAT)Building Address Owner Mailing 'Address City LA .OUI Contractor :',Address P.O. BOX 1504 No'. 0,1 348 78-105 CALLE ESTADO *)80-140 VISTA GRANDE LA QUINTA, CALIFORNIA 92253 6 / DOROTHY TAAi BUILDING* TYPE.CONST. OCC. GRP. K—-L VIESTA GRA DR A.P. Number 617481-007-5 Zip Tel. �+�, "�. 92233 775—Ogb$ Legal Description�,}� Tom' tr5o 0% P{Td L"Cws Project Description Qic2 % Isx.t#hf`l 'MUN PATTA ll^0URR T(`R 0 ' 6 "~R195 714-520-9550 \State Lic. City :.& Classif. Lic. # Arch., Engr., sDesigner 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 Divish 3 of the.Business and Professions Code, and my license is in full force and effect.? ='..SIGNATURE Y F ViJ vT v i:r'-3 ""1 1 3 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 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 or 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 subjects the applicant to a civil penalty of not more than rive hundred dollars (8500). ❑ 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 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 or completion, the owner -builder will have the burden ,o% 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- struct the project.'(Sec. 7044, Business and Professions Code: TheL 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.) ❑ I am exempt under Sec. B. & P.C. for this reason ,.Date Owner WORKERS' COMPENSATION DECLARATION Ihereby 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.'3 _00, Labor Code.) Policy No.Company the 0 Copy is filed' with the city. . ❑.Certified copy s hereby finished. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed it 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., It, 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. 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 wheri 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 of applicant >�i�n A Itn s Date Mailing Address City, State, Zip F � r Sq. Ft. No. No. Dw. Size. 22G Stories Units New ❑ Add Alter ❑ Repair. ❑ -Demolition ❑ Estimated Valuation .. - PERMIT AMOUNT Plan.Chk. Dep. Plan Chk. Bal. Const. Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure TOTAL REMARKS f 3a�*a3�iC�.-k. �� P ri'.�i:, ti.31`7'..E . si •.�°p a 3rt�� • . 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 N0. PLUMBING FEES 1ST FL. SQ. FT. ® $ 2ND FL. SO. FT. ® POR. SO. FT. ® GAR. SQ. FT. ® CAR P. SD. FT. WALL SQ. FT. ® SQ FT ® ESTIMATED CONSTRUCTION VALUATION $ UNITS MOBILEHOME SVC. POWER OUTLET YARD SPKLR SYSTEM BAR SINK ROOF DRAINS DRAINAGE PIPING DRINKING FOUNTAIN. URINAL WATER PIPING NOTE: Not to be used as property tax valuation BONDING FLOOR DRAIN MECHANICAL FEES FORMS WATER SOFTENER VENT SYSTEM FAN EVAP.000L HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE "' DRYER "' GAS (ROUGH) GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED OTHER APPJEQUIP. LAUNDRYTRAY AIR HANDLING UNIT CFM TEMP. POLE 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 ® V4c HOUSE SEWER REMARKS: GAS PIPING PERMIT FEE MIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEE MECH.FEE EPL.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 (ROUG STORAGE TANK FORMS SEWER OR SEPTIC TANK ROUGH WIRING DUCT K 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 GRADING Cu. yd. $ -plus-x$-=j LUMBER GR. F L INSP. FRAMING FINAL INSP. ROOFING REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATION/SOUND FINISH GRADING FINAL INSPECTION 31a Cj CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURES/INITIALS GARDEN WALL FINAL