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SOTB (9495)' IT- P.O. BOX 1504 Building �T 7&No. 995 105 CALLE ESTADO Y Address 5` 00_�`�� LA QUINTA; CALIFORNIA 92253 Owner,, 1P. hyIILS Holmes 1 r BUILDING: TYPE CONST. Mailing , OCC: GRP, � • Address A.P. Number ' City Zip 'kfs� Tel. - • Legal Description Contractor:+°; +:' John R. , iZE"'c1� ney Project Description Address. P. 0. Box 4344 ` '. City.Zip Tel.: Palm L1eseri: 192261 346--8009 State Lia &Classif: B 573A11 City Lic.# Sq. Ft. No. No,Dw. , Size _ Stories Units ` Arch:, Engr. Designer %;r=., New ❑ Add ❑' '.Alter ❑ Repair ❑ Demolition ❑ :- Address Tel: City .. Zip State > Lic. # r LICENSED CONTlRACTOR'S DECLARATION I h'rebyeaffiren t�iatil:am Iicfnsed undergrovisions of Chapter (commencing with Section . 70 01) of Divls n 3 o('itle Business and Pfofessions Code, and my license:is In full force and ect. } z -AIGNATURE Y DATE OWNER -BUILDER DECLARATION , •�,_ I hereby affirm that I am exempt from the Contractoes License Law for the following reason: (Sec.. 7031.5,Business and Professions Code: Any dry or.counly 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 -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 I 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 live hundred doom ($500).. + ❑ f,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 4o an owner of property who builds or Improves thereon and who does such work himse0 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.) .' Estimated Valuation 1800 • V Q ••-� PERMIT - - AMOUNT - - -Plan. C'.hk. Dep. .• Plan Chk. Bal. Const. ^ •3 . tl Mech. - - '- Electrical . Plumbing w ❑ 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 LicenseLaw • 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.) ❑ I am exempt under Sec. B. 8 P.C.- for this reason •: S.M.I: " • . - Grading - Driveway Enc.,,,, Date owner Infrastructure WORKERS' COMPENSATION DECLARATION i 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. TOTAL • �- 3 0 . 00 s _ CERTIFICATE OF E)(EMPTION FROM WORKERS'COMPENSATIOWINSURANCE •-- - REMARKS - - (This section need not be completed if the permit is for one hundred dollars 4$100) valuation- • or less.) - . • - ,. I certify that in the performance of 1hp work lot which.this�pehnit is issued, I shall not�.ff employ any person In any man er so ash become, urkers'-ompensation tiject-to he:Wo Laws of California.XV ' Date Owner ` NOTICE TO APPLICANT: If, a er rrg tins rrrlrrate of Exemption- yo `sfrould become subject to the Workers' Comdua�lapensation provisions of the Labor Code, you must loRhvith - comply with such provisions or this permit shall be deemed revoked: - 1']£3, .roti,;! to t ILr Arg ZONE: BY: ' - - Minimum Setback Distances: , ',. •' - ` - Front Setback from Center Line i Rear Setback from Rear Prop. Line CONSTRUCTION LENDING AGENCY 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.) - - Lender's ;Name FINAL DATE Side Street Setback from Center Line -- Side Setback from Property Line ' INSPECTOR Lenders*Address • 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. 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. Issued by: Validated by: Date Permit • ` 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. 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 ROUGH PLUMB. 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 GAS (ROUGH) LAUNDRY TRAY AIR HANDLING UNIT CFM HEATING (FINAL) 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 BOND BEAM SO. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 1 Vi c SEWAGE DISPOSAL LUMBER GR. SO.FT.GAR ® 3/Ic HOUSE SEWER FRAMING FINAL INSP. 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: %� • �`%�� y/ 3 0 Y - P�/{��j4/ VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATIONISOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURES/INITIALS GARDEN WALL FINAL