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MISC (002047)Building Address _51- Owner Si Owner P.O. BOX 1504 No, 002047 78-105 CALLE ESTADO 00 lea Nriliiwro.. LA QUINTA, CALIFORNIA 92253 Mailing" : - Address $.o.B=cmc City Zip Contractor .�y'��'. ` �y Address Zip Tel: 12� 9 2 2.5A 564-4104— BUILDING:- 5 4104 BUILDING:- TYPE CONST.- OCC: GRP. A.P. Number Legal Description Project Description OMMU: Vii!' - State Lic. " City & Classif.. Lic. # Sq. -Ft. No. • 'No. Dw. Size . > ... ....... .. Stories....... .Units .. Arch:; Engr.; .. ... .> ._ .. _ Designer New 0 ' Add ❑ = Alter ❑', Repair ❑ Demolition ❑ ` Address " Tel. , City• Zip State . - LICENSED CONTRACTOR'S DECLARATION.� 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 full force and _ .. effect. _ SIGNATURE DATE -. OWNER -BUILDER DECLARATION Estimated Valuation . '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 -- - - perm( 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 .� PERMIT - AMOUNT ' the provisions o/ the Contractor's License Law, Chapter 9(commencing with Section .7000) bf Division 3 of the Business and Professions Code, or- that. he is exempt. therefrom, andthe basis ' for the alleged exemption. Any. violation of Section 7031.5: by 'any applicant for a .permit. •. - - .Plan.Chk. Dep.'-. - - - - ' subjects the applicant to a -civil penalty o/ not more than five hundred dollars ($500)."`- ' • • ' - Plan Ghk. Bal. - - .• ' ❑ 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 ' COr1St. Professions Code: The Contractor's License Law does not apply, !o an owner of -property who: . builds or improves .'thereon and who does such work `himself or. through his own employees, : Meth. • 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 . Electrical o/ proving that he did not build or improve for the purpose of sale.). r. ,. > ❑ 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 • S.M..I.— such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) - - Grading - Q I am exempt under Sec. B..g P.C. for this -reason .. .. Driveway Enc. Date C� row ern � %'r"%"�` .' nff raster=ucture ssI ryry 10M 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..: Cl Certified copy is hereby furnished. - TOTAL 100.00 ' CERTIFICATE OF EXEMPTION FROM REMARKS WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit 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. 'r employ any person in any manner so as to become subject'lo the Workers' Compensation' . Laws of California. Date , . . Owner .. , NOTICE TO APPLICANT: If, after making this Certificate of Exemption you• should become "' ZONE: -` BY: ' • subject to the' Workers" Compensation provisions'o/'the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. ' •• •MInIfTIUmSetback-DlStanC@S:. - - 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, m_is.permit.is issued. (Sec. 3097, Civil Code.) Side Setback from Property Line Lender's Name ' Lender's Address 'signed FINAL DATE INSPECTOR: • This is a building permit when properly filled out, 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. - Issued by: Date Permit -. 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 - Validated by: Signature ofapp licant,f rfc✓/ 1'1%%ter" Date-ef -% - Mailing Address,, %�-C �' `" ' Validation: City, State, Zip _ • HARD COPY _ . _ CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SQ. FT. p $ 2ND FL. SQ. FT. ® POR. SO. FT. ® GAR. SO. FT, ® CAR P. SQ. FT. WALL SQ. FT. ® SQ. 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 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 APP.IEQUIP. LAUNDRY TRAY AIR HANDLING UNIT CFM TEMP. POLE 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. SQ. FT. ® c BATH TUB SQ. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 11/a c SEWAGE DISPOSAL SQ.FT.GAR ® 3/ac HOUSE SEWER REMARKS: VENTILATION 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.IEQUIP. 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 SIGNATURES/INITIALS GARDEN WALL FINAL