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04962 (SFD)t t1 l , v,r P.O. BOX 1504 wilding 78-105 CALLE ESTADO Address 54-604 Inverness LA QUINTA, CALIFORNIA 92253 Mailing Address 42—AMiQ Cook St a t CT t43 City Zip Tel. Contractor Satre Zip Tela State Lic. City &Classif. "288130 Lic.# 328, Arch., Engr., Designer Address Tel. City(Zip I State Lic. # J 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 }ffull force and effect. SIGNATURE DATE OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractors License Law for the following reason: (Sec. 7031.5,Busriness 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 We 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, and the basis for the alleged exemption. Any violation or Section 7031.5 by any applkxnt for a permit subjects the appficarht to a thud penalty of not more than five hundred dollars ($500). ❑ 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 properly 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 safe. lf, however, the building or improvement is said within one year of completion, the owner -budder will have the burden of proving that he did not build or improve for the purpose of sale.) ❑ 1, 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 doesnot 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 am exempt under Sec B. & P.C. for this reason Date - owner WORKERS' COMPENSATION DECLARATION 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'• ❑ Copy is filed with the city. , ❑ Certified copy is hereby furnished. ,r' ' CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not 'be completed If the pemBt 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 Califomia. Date Owner NOTICE TO APPLICANT: h after making this Certificate of Exemption you should become subject to the Workers' Compensation provisions or the Labor Code, you mist forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY Ihereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, C" Code.) Lenders' Name Lenders 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 ateMailing Address City, State, zip 7..r�,, r � lt� No. 04962 BUILDING:. TYPE CONST. OCC: GRP.- A.P. Number RCA Went — TrA1Ct 22432-2 Legal Description Project Description rliAnis 7AR _ VIA" 40M REMARKS 11.t;G•t i-1" x? 77AA "!.-f - to 'c.H�.it'� 'l i f ti -E.- 3 OU a, t 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 12/8/88Permit Validated by: Validation: r Sq. Ft. 3142 Size f. A C. No. Stories No. Dw. Units` New ❑ - Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation 115,834 PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. 593.44 Const. 723.00 Mech. 55.00 Electrical 128.65 Plumbing 140.50 S.M.I. 15.09 Grading Driveway Eno, Infrastructure $4,856.26 2,428.13 Crmdit 2.428.13 y `+ TOTAL S4.083.81 REMARKS 11.t;G•t i-1" x? 77AA "!.-f - to 'c.H�.it'� 'l i f ti -E.- 3 OU a, t 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 12/8/88Permit Validated by: Validation: r t CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES IST SO. FT. ® $ UNITS SLAB GRADE �L. BONDING YARD SPKLR SYSTEM 2ND SQ. FT. @ FORMS SEWER OR SEPTIC TANK ROUGH WIRING MOBILEHOME SVC. BAR SINK POR. SQ. FT. ® GAS (ROUGH) METER LOOP GAR. SQ. FT. ® POWER OUTLET ROOF DRAINS S (FINAL) TEV. POLE DRAINAGE PIPING CAR P. SQ. FT. @ GROUT WATER HEATER WALL SQ. Ff. FINAL INSP. DRINKING FOUNTAIN BOND BEAM WATER SYSTEM URINAL SQ FT ® _$ LUMBER GR. ESTIMATED CONSTRUCTION VALUATION $ FINAL INSP. WATER PIPING NOTE: Not to be used as property tax valuation FLOOR DRAIN MECHANICAL FEES WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER VENTILATION GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED FIRE ZONE ROOFING LAUNDRYTRAY AIR HANDLING UNIT CFM FIREPLACE 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. SQ. FT. ® c BATH TUB SO. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 1+/. c SEWAGE DISPOSAL SO.FT.GAR ® 3/ic 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 ROCK STORAGE FOUND. REINF. GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APP.IEOUIP. REINF. STEEL S (FINAL) TEV. POLE GROUT WATER HEATER E/ ��' FINAL INSP. BOND BEAM WATER SYSTEM GRADING cu. yd. $ -plus-4 _$ LUMBER GR. FINAL INSP. FRAMING 3-y FINAL INSP. OFING REMARKS VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR R. FIREWALL THING � -�7 MY H SULATION/SOUND 3 F ISH GRADING INAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURES/INITIALS GARDEN WALL FINAL