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05495 (SFD)P.O. BOX 1504 N o . Building 7&105 CALLE ESTADO Address$��°`��a �� LA QUINTA, CALIFORNIA 92253 Owner I :Thelma Czossmm 05495 Mailing BUILDING: TYPE CONST. OCC: GRP." g0i Address � Ave. :5• A.P. Number 617-64G-044 City Zip Tel. Lot 44 Northridge 92324 E.181349-5394 Legal Description Contractor t Plan 2 James C. Cashman Project Description Address '77--200 Minnesota City Zip Tel - - Palm Desert" 92260' 0191345--5430 State Lic- City S Classif. - jg 195333 Lic. # 250 Arch., Engr., Designer Address' Tel City Zip State 1 Lic: # LICENSED CONTRACTOR'S DECLARATION Ihereby 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 imfutbforce and effect .t ,.%::•r ., y''/,.,;f�l„r•�-." ,7 {/` .{.NATURE - "'d" X DATE OWNER -BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractors License Law for the following reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a parmit 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 alvision 3. of the Business and Professions Code, or that. he is exempt therefrom, and the basis for the alleged exemption. Any violation ofSection 7031.5 by 'any applicant for a permit suf#eets 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 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= thereon and who does such, work himself or through his own employees, provided that such improvements are not intended or offered for sale. ff, 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 snprove 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: The Contractor's License Law does notapply 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 Date Owner WORKERS' COMPENSATION DECLARATION r. 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 - f] 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 (5100) valuation or less-) I certify that in the performance of thg 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 ff, after making this Certificate of Exemption you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith (comply will) such provisions or this permit shall be deemed revoked. CONSTRUCTIONLENDING 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 of applicant Date Mailing Address City, State, Zip ZONE: BY: Minimum Setback Sq. Ft. Size- 1052. No. Stories No. Dw. Units New'❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Side Street Setback from Center Line Side Setback froLn-Property„Line` FINAL DATE INSPECTOR 3114/39 Issued by: Date Permit Validated by: Estimated Valuation��is92�• PERMIT•• • - AMOUNT Plan Chk. Dep. " Plan Chk. Bal.+ Const. Mech. EJ. Electrical Plumbing$. S.M.I. 7.iUT Grading Driveway Enc. Infrastructure s+ rT1ge-toe 3 t a 0 TOTAL 'r�; y t �_ , IV 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 froLn-Property„Line` FINAL DATE INSPECTOR 3114/39 Issued by: Date Permit Validated by: Validation: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SO. FT. $ UNITS SLAB GRADE vJ OUGH PLUMB. BONDING YARD SPKLR SYSTEM 2ND FL SO. FT. FORMS SEWER OR SEPTIC TANK ROUGH WIRING. MOBILEHOME SVC. BAR SINK POR. SO. FT. @ S (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 SO. FT. @ FINAL INSP. DRINKING FOUNTAIN. SO FT @ WATER SYSTEM URINAL ESTIMATED CONSTRUCTION VALUATION $ =$ WATER PIPING NOTE: Not to be used as property tax valuation ROOFING /�/ VENTILATION FIRE ZONE ROOFING: FIREPLACE SPARK ARRESTOR GAR. FIREWAL LATHING MESH INSULATION/SOUND 9/51 FINISH GRADING FINAL INSPECTION CERT. OCC. -1i -1A _ FLOOR DRAIN MECHANICAL FEES REMARKS: 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 I 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 l SO. FT. @ c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID @ 11/4 c SEWAGE DISPOSAL SO.FT.GAR @ V4c 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 SETBACK GROUND PLUMBING UNDERGROUND A.C. UNIT COLL. AREA SLAB GRADE vJ OUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMS SEWER OR SEPTIC TANK ROUGH WIRING. DUCT WORK ROCK STORAGE FOUND. REINF. S (ROUGH) METER LOOP HEATING (FINAL) OTHER APPJEOUIP. REINF. STEEL GAS (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM GRADING cu. yd. $ plus x$ =$ LUMBER GR. INAL INSP.I2 — `— O� _ 1 i FRAMING FINAL INSP. "7(V ROOFING /�/ VENTILATION FIRE ZONE ROOFING: FIREPLACE SPARK ARRESTOR GAR. FIREWAL LATHING MESH INSULATION/SOUND 9/51 FINISH GRADING FINAL INSPECTION CERT. OCC. -1i -1A _ d Y C__lip ? � 1 REMARKS: SIGNATURESIINITIALS GARDEN WALL FINAL