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002239 (SATT)44 P.O. BOX 1504 No.. 002239 Building 856 U@ f, 78-105 CALLE ESTADO Address LA QUINTA, CALIFORNIA 92253 Owner mailin Address %S+-005 C*Mtxy C,Ub Dr. City Palm Deseft Zip 92260 Tel. 5682828 Contractor " Address Scm ' City":;a=Zip ' . .Q/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, atter, 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 the provisions o/ the Contractor's License Law, Chapter 9 (commencing with Section.7000) of Division 3 o/ the Business and Professions Code, or that. he is exempt therefrom, and'the basis for the alleged exemption. Anyviolation of Section 7031.5 by 'any applicant for a permit subjects the applicant to a civil penalty of not more than live hundred dollars .(S500):' ❑ 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 o/ property who builds orimprovesthereon and who does such work himself or through his own employees, provided that such improvements are not intended or offered /or sale. If, however, the building or Improvement is sold within one year of completion, the owner -builder will have the burden o/ 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 does not apply to an owner o/ property who builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) - O I am exempt under Seca B. & P.C. for this reason - Tela State Lic. & Classif. 288130 City Lie. # 328 Arch., Engr.,' Designer Mech.. _ Address Plumbing Tel. BUILDING: TYPE CONST. OCC: GRP. A.P. Number Legal Description Project Description. P" '111M VLM 30 Rnaw7B Sq. Ft. 2$25 No. No. Dw. Size . GM 56a • Stories Units - New ❑Z Add ❑ Alter ❑ Repair ❑ Demolition ❑ City JZip 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.infull force and effect. " SIGNATURE •yr �. ,+.'. e� i. -k ••«.. ►..-^4,.. i i DATE . ' . .Q/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, atter, 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 the provisions o/ the Contractor's License Law, Chapter 9 (commencing with Section.7000) of Division 3 o/ the Business and Professions Code, or that. he is exempt therefrom, and'the basis for the alleged exemption. Anyviolation of Section 7031.5 by 'any applicant for a permit subjects the applicant to a civil penalty of not more than live hundred dollars .(S500):' ❑ 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 o/ property who builds orimprovesthereon and who does such work himself or through his own employees, provided that such improvements are not intended or offered /or sale. If, however, the building or Improvement is sold within one year of completion, the owner -builder will have the burden o/ 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 does not apply to an owner o/ property who builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) - O I am exempt under Seca B. & P.C. for this reason - Estimated Valuation - PERMIT Plan Chk: Dep.. Plan Chk. Bal. Const. Mech.. _ Electrical Plumbing S.M.I. ' Grading Driveway Enc. Date owner Infrastructure 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. CERTIFICATE OF EXEMPTION FROM .WORKERS' COMPENSATION INSURANCE (This section need not be completed it the permit is for one hundred dollars ($100) valuation • or less.) I certify that in the performance of th@ 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: It, 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. - TOTAL 178,307.00 AMOUNT • � .J4yy//i�• {L•��7 �� ..���J 1 -71 136.50 12.36 REMARKS ZONE: BY: 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,Llne ' Lender's Name Lender's Address This is a building permit when properly filled out, signed'and validated, and is subject to FINAL DATE INSPECTOR expiration if work thereunder is suspended for 180 days. i�7—iy I certify that I have read this application and state that the'above information incorrect. Issued by: Date �VSI Permit 1 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: i�:; ;. r Signature of applicant � 2 - r Date * v Mailing Address t' �' ! Validation: City, State, Zip A5U96 4 8-.1 :5485,17 CK HARD COPY CONSTRUCTION ESTIMATE Aft NO. ELECTRICAL FFAft NO. PLUMBING FEES 1ST FL. SO. FT. ® $ 2ND FL. SO. FT. POR. SO. FT. ® GAR. SO. FT. ® CAR P. I SO. FT. WALL SO. FT. ® . SO. FT. ® ESTIMATED CONSTRUCTION VALUATION $ UNITS MOBILEHOME SVC. POWER OUTLET YARD SPKLR SYSTEM BAR SINK ROOF DRAINS DRAINAGE PIPING DRINKING FOUNTAIN URINAL WATER PIPING NOTE: Not to be used as property tax valuation FLOOR DRAIN MECHANICAL FEES HEATING (ROUGH) WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER DUCT WORK GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED LAUNDRY TRAY AIR HANDLING UNIT CFM HEATING (FINAL) 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 WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 11/a c SEWAGE DISPOSAL SO.FT.GAR ® 3/ac HOUSE SEWER FINAL INSP. ,�G ROOFING n ,' 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 ROUND PLUMBING p UNDERGROUND A.C. UNIT COLL. AREA )A SLAB GRADE ( ROUGH PLUMB. 8 BONDING HEATING (ROUGH) STORAGE TANK FORMS SEWER OR SEPTIC TANK OUGH WIRING C DUCT WORK ROCK STORAGE FOUND. REINF. GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APPJEOUIP. REINF. STEEL (/GAS (FINAL) / TEMP. POLE GROUT WATER HEATER SERVICE XteINAL INSP. f.7, Lk BOND BEAM WATER SYSTEM GRADING cu. yd. $ plus x$ _$ LUMBER GR. INAL INSP. // p /i r tG FRAMING Q f; �O/_ U¢ FINAL INSP. ,�G ROOFING n ,' & � REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING Gr MESH INSULATION/SOUND FINISH GRADING FINAL INSPECTION G, CERT. OCC. FENCE FINAL IN5YtG I UI1'S 5R9NA I UMt511NI I IALS_ GARDEN WALL FINAL ruc Qat,_,,vC q,5,Y(0,