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10978 (MISC)7Q ` _0 P.O. BOX 1504 N o . 10978 Building 49--258 Vista Bonita 78-105 CALLE ESTADO Address LA QUINTA, CALIFORNIA 92253 Owner BUILDING: TYPE CONST.. OCC: GRP. - Mailing Address Same A.P. Number City Zip Tel. La Quinta Ca. 564-n3891 Legal Description Add I AIC nuc:: Contractor Project Description Address Same City Zip Tel.: State Lic. City & Classif. Lic. # Sq. Ft. No. No. Dw. ' Arch., Engr„ Size Stories Units Designer New ❑ Add ❑ Alter ❑. Repair ❑ Demolition ❑ Address Tel. ' a r City Zip State WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to* self -insure, or a'certilicate of Worker's Compensation lnsurance,.or a certified copy ,thereof. (Sec. 3800,.Labor Code.) . Lic. # Policy No. Company LICENSED CONTRACTOR'S DECLARATION ❑ Copy is filed.with the city. ❑,Certified copy is hereby furnished.tr"N"' I hereby affirm that 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. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE _SIGNATURE DATE (This section need not bejcoinpfeted if the permill is for hufdred dollars (5100) valuation or less.) f 1 t - ' 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, after, improve, demolish, or repair any structure, prior to its issuance also requires the applicant for such permit to rile a signed statement that he is licensed pursuant to " j' I certify that in the performance of the work fofwhich this` it s issued, I'shall not Estimated ValUatlOf PERMIT the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of NOTICEJ,TO APPLICANT: If, (after making this Certificate of Exemption you should'become ' Division 3 of the Business and Professions Cade, 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 ' _ Plan Chk. Dep. subjects the applicant to's civil penalty of not more than five hundred dollars ($500). - ' q�Q( as owner of the property, or, my employees with wages as their sole compensation, will Plan Chk. Bal. d 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 Const.' 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. It however, the building Mech. or improvement is sold within one year of completion, the owner-buAder will have the burden of proving that he did not build or improve for the purpose or sale.) EI@CtflCal ❑ I, 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 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 I ! O I am exempt under Sec. B. & P.C. for this.reason "S.M.I. Grading AMOUNT Date 7/Owne, tr p �/` ---. -- Infrastructure ' a r WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to* self -insure, or a'certilicate of Worker's Compensation lnsurance,.or a certified copy ,thereof. (Sec. 3800,.Labor Code.) . Policy No. Company ;.44' [3µf4� ��r. �L? "'S'" Ps'! `S f1 Ah ❑ Copy is filed.with the city. ❑,Certified copy is hereby furnished.tr"N"' w TOTAL v - u. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE REMARKS (This section need not bejcoinpfeted if the permill is for hufdred dollars (5100) valuation or less.) f 1 t - j' I certify that in the performance of the work fofwhich this` it s issued, I'shall not .. employ any on in any manner so as to beco'nie subject to the 11Votk�s' Co pensation' ' Laws bf Califo�rj4, f/ t?. Date �I her t I {j 9 V NOTICEJ,TO APPLICANT: If, (after making this Certificate of Exemption you should'become ZONE: BY: subject to the Workers' Compensation provisions of the Labor Code, you must Iorthwirh comply with such provisions," or this permit shell be deemed revoked. Minimum Setback Distances: ` Front Setback from Center Line r ~� 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 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 Issued by: Date Permit 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 CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SO. FT. ® $ 2ND FL. SO. FT. ® POR. SO. FT. ® GAR. SO. FT. ® CAR P. SO. FT. WALL SO. FT. ® SO. FT. ® ESTIMATED CONSTRUCTION VALUATION $ UNITS MOBILEHOME SVC. POWER OUTLET a YARD SPKLR SYSTEM BAR SINK I 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.COOL HOOD, SIGN WASH ER(AUTO)(DISH) APPLIANCE DRYER GAS (ROUGH) GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED OTHER APPJEOUIP. LAUNDRY TRAY AIR HANDLING UNIT CFM TEMP. POLE 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 SO. FT. ®c IWATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 11/4 c SEWAGE DISPOSAL SO.FT.GAR ® V4c 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 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 REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATION/SOUND FINISH GRADING FINAL INSPECTION - CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURES11NITIALS GARDEN WALL FINAL TO o uca a ►�(� �D 'r�T r RooFi ` ' %'1 n 1 STUCCO Nvust i i Z4 0- Z 14 W OV�`fL WALL (�uL;,t AUTP `` Z"xa" SuPPon,TS i �nl Y�uoF � sT Cc o FAA i a G P/hNTU. / TO MA --fl* t U16.SITPWb 5 uppolITs 41 SaGTior k C Nv sM e) PLAN] sCALO