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10964 (PAT)P.O. BOX 1504 N O . .5. ©Z10''t Building 78--655 Villeta Dr. 78-105 CALLE ESTADO Address LA QUINTA, CALIFORNIA 92253 Owner Darryl speach Mailing Sr�iiO Address Cityl,a Quina Zip 92253 Tel. 360-1:84 Contractor / BUi lde r Address BUILDING: TYPE CONST. OCC: GRP. A.P. Number Legal Description Project Description City Zip Tel.: State Lic. City & Classif. Lic. # Sq. Ft. Size �� No. No. Dw. Stories Units • Arch., Engr., Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ 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. 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 of county which requires a Estimated Valuation r. 4 s s• 50 - PERMIT- _ AMOUNT permit to construct, after, improve, demolish, or repair any structure, prior -Jo Its Issuance also - . requires the applicant for such permit to rile 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 Business and Professions Code, or that. he is exempt therefrom, andthe basis for the alleged exemption. Any violation of Section, 7031.5 by 'any applicant for a permit ects ,subjsubjects the applicant to civil penalty of not more than five hundred'dollars.($500):- l, as owner of the property, or my employees with wages as their sole compensation, will work, and the structure:is not intended'or offered for sale. (Sec. 7044, Buisness and Professions Code: The Contractor's License Law does not apply to an owner of property who Plan Chk: Dep. - Plan Chk. Bal. 40. 95 Const. - - A3 . Q0 Mech. ' builds or Improves thereon and who does such work himself or through. his own employees, . provided that'such improvements are not, intended.or offered tor.sale. If, however, the.building . Electrical _ or improvement is sold within one-year of completion, the owner -builder will have the burden . of proving that he did not build or improve for the purpose of sale.) Plumbing ._ ' ❑ I, as owner of the property, am exclusively contracting with licensed contractors to con- strucl the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property -who builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) ❑.J am exempt under Sec. B. & P.C. for this reason S. M. 1. - .40 Grading Driveway Enc. f j A`e"� Date ��.�•r/'�� Owner.f --`�` J` -�" r -...r f:- .. Infrastructure WORKERS' COMPENSATION DECLARATION ' I hereby affirm that I have a certificate of consent to self -insure, or a certificateof Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor.Code.)- Policy-No. Company 7ilrjisT$lY'-S✓i°�.��:G y4,tS r<sv. ❑ Copy is, filed with the city. ❑ Certified copy is hereby furnished. _ TOTAL f NA. 35 rte ? i f , 4' %I+ •' r ' CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE REMARKS - . (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 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: If, 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. - ZONE: BY: ' - MIhIn1UnlSetbackDistances: - 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 Name Lender's Address FINAL DATE INSPECTOR 'This is a building permit when properly filled out, signed and validated, and is subject to expiration it work thereunder is suspended for 180 days. ' ].Certify that I have read this application and state that the above information is correct. 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. Issued by: Validated by: Date Permit - Signature of applicant Date Mailing Address Validation: City, State, Zip CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES IST FL. SQ. FT. ® $ UNITS COLL. AREA 2ND FL. SQ. FT. ROUGH PLUMB. YARD SPKLR SYSTEM POR. SQ. FT. ® MOBILEHOME SVC. BAR SINK GAR. SQ, FT, ® POWER OUTLET ROOF DRAINS CAR P. SO, FT. DUCT WORK DRAINAGE PIPING WALL SQ. FT. @ GAS (ROUGH) DRINKING FOUNTAIN. SQ FT ® HEATING (FINAL) URINAL ESTIMATED CONSTRUCTION VALUATION $ GAS (FINAL) WATER PIPING NOTE: Not to be used as property tax valuation FLOOR DRAIN MECHANICAL FEES WATER HEATER WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER WATER SYSTEM GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED GRADING cu. yd. plus x$ 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. SQ. FT. RESID ® 11/4 c SEWAGE DISPOSAL SQ.FT.GAR ® 3/4c 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 ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMS SEWER OR SEPTIC TANK ROUGH WIRING. DUCT WORK ROCKSTORAGE FOUND. REINF. GAS (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. FINAL INSP. FRAMING FINAL INSP. ROOFING i %��y ��Z /I/��� •O /I/��� — �" Olt REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATIONISOUND FINISH GRADING FINAL INSPECTION - CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL ep4 , I I i r e � 11 I i I� ff Iii _.�'I_- Iii � 1 I c Ijl � I I I I I ;. ��+I_ 11 161 �'. I t ISI 11 � i'I I I S ��� •�E���= E 1 +Ju T, IT, u Ul DAN 8 SAFE lY ARTADEPE N — T 01,0? 10119 10 A LY ,CCE PTED I `OF C NTR X10 4 SUBJECTX TO INS TI ON S PER sr�c-�•s'�'-- - -- ¢�-n� � Pb1T � .,..�! � E � � � � � I � ! � -- 4Y u,00b 11— L y C � � � i � /RJ CON �lPT'�'1 I e4 i � ! �� /o � l�G%L Ze 74