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002369 (BLCK)ot P.O. BOX 1504 Building 78-105 49'-'222 Ami& V� � LA QUINTACCALIFORNIA 92253 Address ' Owner lain No. 002369 BUILDING: TYPE CONST. - OCC: GRP. - Mailing Address 420220 Gmenmr A.P. Number. 773-350-025 City ZipTel. tot 25 Palm Da�p't 92260 341-2955 Legal Description - Contractor Project Description C=*s - Address .. .. . City. _ Zip .. .. Tel.' La Quifta 92253 .56�315 State Lic. City & Classif. � Lic. # 159 �W Sq. Ft. No. No. Dw. 145 Un!P .' Size Stories Units 'Arch.,.E�g�. .... Designer New ❑X Add ❑ Alter ❑ Repair ❑ Demolition ❑ Address Tel. City r' Zip State _ T--3—fMt' :4"h- SE'.b2ii'!'3m w&U 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 Estimated Valuation I hereby affirm that I am'exempt from the Contractors License Law for the following 2.175.00 . reason: (Sec. 7031.S,Business and Professions Code: Any city or county whicA 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 thathe is 'licensed pursuant to . • - - PERMIT. - - ' ' AMOUNT the provisions of the Contractor's License Law, Chapter9 (commencing with Section 7000) of. . - Division 3 of the Business and Professions Code, or that -he is. exempt therefrom, and the basis ' for the Any Section 7031.5. by 'any for _ Plan Chk. Dep.' - - - - alleged exemption. violation.of applicant a permit ' -subjects the applicant to a civil penalty of not more than five. hundred dollars ($500). ' . - " : • • ' - Plan Chk. Bal. LS L 25 02 0, 1, as owner -of the, property, or my employees with ages as their -sole compensation, will do the work, and the structure is not intended or offered for sale. (Sec. •7044, tduisness and , Const. ++pper�, Professions Code: The Contractor's. License Law does not apply to an owner of property who. 38.50 builds or improves thereon and who does such work himself or through his own employees, Mech'. 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 Electrical of proving that he did not build or improve for the purpose of sale.) - . .. , - 0. 1, as owner of the property, am exclusively. contracting with licensed contractors to con- Plumbing struct the project. (Sec. 7044, Business and Professions Code: The Contractor's. License Law does to who builds improves thereon, who for ... .. S.M.I." not apply an owner of property or and contracts such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) - Grading . , O I am exempt under Sec. B. & P.C. for this reason Driveway Enc. Date owner Infrastructure WORKERS' COMPENSATION DECLARATION 'I hereby affirm that I have a certificate of'cdnserit to self -insure, or a certificate of Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, labor Code.) Pol icy. N o. Company 0 Copy is filed with, the city. ❑.Certified copy is hereby furnished'. TOTAL 64.02 CERTIFICATE OF EXEMPTION FROM REMARKS 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 youshould become. ZONE: BY: ' subject to 'the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. - _ Minimum Setback Distances: - ' 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. !�-99 86 I certify that I have read this application and state that the above information is 'correct. Issued by: -Date ' Permit 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. Validated by: Signature of applicant Date Mailing Address Validation: City, State, Zip A5573 5 9 64,'02 U HARD COPY CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SO. FT. ® $ 2ND FL. SO. FT. ® POR. SQ. FT. ® GAR. SO. FT. ® CARP. SO. FT. ® WALL SO. FT. ®DRINKING SQ. FT. ® ESTIMATED CONSTRUCTION VALUATION $ UNITS MOBILEHOME SVC. POWER OUTLET YARD SPKLR SYSTEM BAR SINK I ROOF DRAINS DRAINAGE PIPING 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.COOL HOOD SIGN WASH ER(AUTO)(DISH) APPLIANCE DRYER GAS (ROUGH) GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED OTHER APP.IEQUIP. LAUNDRY TRAY 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. SQ. FT. ®c BATH TUB SQ. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 11/4 c SEWAGE DISPOSAL SQ.FT.GAR @ 3/ac HOUSE SEWER REMARKS: 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 ROCK STORAGE FOUND. REINF. GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APP.IEQUIP. 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 REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATION/SOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL r' w - f j, _ P Y ``' � ©.w .� . �' i n.y� _4 t � ..,� L,� ,..�7 r �,� ��.. `.�# iSVi[� a' 1'. i '+rAi, �1.� N �•� J t7 i� -.•.� • �� i - _ ijol � � + ♦ C�ti� cwt,. � �,'x.� s �. f ''�. r' , �' �.,i. i 13' F4„ 1 ;_ ^'�, y y�4 S' . ft. � 'f ,^.r'T � �' i ' ff � �� S f. `i _ i h—.+ ,—��- ' �� j ^S . - • .C� 1 - _ _ �--t.��'S%..a s� a �._ —.�,_ � .-�.z Z. ti..—..- r. y � - - - 6 St�gi,L LM F fi 1 d' r' ©.w S i '+rAi, if - _ ijol 44 EvJ 'fib �Lviqp ' - - - 6 St�gi,L LM F 1 d' ' S 15 q ✓ r h • a �L [ . '+rAi, �Tp.