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04721 (SFD)Buildigg f_• � Address OWner Mailing Address 82"439 Priscilla. Ct. ",;City Zip Tel. Indio 92201 _347 CContracto ' i4�t t 4r_ y. t P.O. BOX 1504 r 78-105 CALLE ESTADO ,? £" LA OUINTA, CALIFORNIA ,92253, , City Zip Tel. State Lic. City & Classif. Lic. # Arch., Engr., • Designer 0 - .• Address Tel, .r v City lZip ' BUILDING: TYPE CONST. OCC. GRP. A.P. Number 769-360-019 022 Legal Description •, I I Lic_ # • . LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) t. of Division 3 of the Business and Professions Code, and my license is in full force and ffec SIGNgTURE PATE �� OWNER -BUILDER DECLARATION I hereby aifirm 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, 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 Division 3 of the Business and Professions Code, 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 subjects 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 improves thereon and who does such work himself or through his own employees, `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 of proving that he did not build or improve 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 I� does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractors) licensed pursuant to the Contractor's License,Law.) ❑ 1 am exempt under Sec. B. & PSC. for this reason er�� r• r /Date /a>�`*�.'' 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. oject Description .i e%. -' "Lv, This pormit replaces #04057-' thanlgra of Contractor Sq. Ft., Size No. Stories "- No. Dw. ' `Units i New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Pool Not. Tricluille4 451 of 61 block wall '')I certify that in the performance ofithplwork for which this permit is issued, I shall not _ `employ any pperson in any manner; so as to become subject to the Workers' Compensation Laws of California r� r Owner ,..3�' /�f � Estimated Valuation -0— 0 -PERMIT ., ZONE: PERMIT subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. AMOUNT Plan Chk. Dep. L Plan Chk. Bal. _ Rear Setback from Rear Prop. Line Const. - Side Street Setback from Center Line Mech. Electrical - Side Setback from Property, Line - Plumbing ; S.M.I. DATE ,: ,. • r. Grading �. ' Driveway Enc. Issued by: - Infrastructure r, J TOTAL - •.. CERTIFICATE OF EXEMPTION FROM REMARKS. WORKERS' COMPENSATION INSURANCE (This section,need not be completed it,the permit Is for one hundred dollars ($100) valuation ' orless. fi '')I certify that in the performance ofithplwork for which this permit is issued, I shall not _ `employ any pperson in any manner; so as to become subject to the Workers' Compensation Laws of California r� r Owner ,..3�' /�f � AP7` NOTICE TOPLICANT: If,'�altei making this Certificate ,of Exemption you should 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 ' V 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 AddressFINAL DATE INSPECTOR This is a building per when properly filled out, signed and validated, and is subject to • expiration It work thereunder is suspended for 180 days. �. ' •I certify that I have read this application and state that the above Information is correct: Issued by: Date Permit ,Ato 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 WHITE - FINANCE, PINK - APPLICANT, GREEN- BUILDING, GOLDENROD-- ASSESSOR'S OFFICE, HARD COPY - FILE' L CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMPING FEEI.. IST FL SO Fl y S UNITS SLAB GRADE ROUGH PLUMB BONDING YARD SPKLR SYSTEM 2ND FL SO FT. Ct FORMS SEWER OR SEPTIC TANK ROUGH WIRING MOBILEHOME SVC. BAR SINK POR SO FTa GAS (ROUGH) METER LOOP GAR SO. FT. to POWER OUTLET ROOF DRAINS GAS (FINAL) TEMP. POLE DRAINAGE PIPING CAR P. SO FT. 4V GROUT WATER HEATER WALL SO. FT. Q FINAL INSP. DRINKING FOUNTAIN SO. FT. I'd WATER SYSTEM URINAL ESTIMATED CONSTRUCTION VALUATION $ LUMBER GR. WATER PIPING NOTE: Not to be used as property tax valuation FRAMING FLOOR DRAIN MECHANICAL FEES ROOFINGQ WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTONDISHI APPLIANCE DRYER FIRE ZONE ROOFING GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED LAUNDRYTRAY 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. SO. FT. ® c BATH TUB SO. FT. @ c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID g I V: c SEWAGE DISPOSAL GARDEN WALL FINAL SO.FT.GAR (g 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 8 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 GAS (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM GRADING cu. yd. y -Plus-x$ =S LUMBER GR. FINAL INSP. FRAMING FINAL INSP. ROOFINGQ Dr� �lea,p ��Z �O. L// g Oeeli 2 �� GJitLt S�� h Lel/-PLL. /� L wov 70 /- 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