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04937 (SFD)T-,ity 4 4 Qum& P.O. BOX 1504 Building 78-105 CALLE ESTADO Address 78-6?,5 Via Corridb LA QUINTA, CALIFORNIA 92253 Owner Mailing Address City Zip Tel. Gi-t, 92234 773-9024 Contractor SR0,e Address City Zip I Tel. State Lic. City & Classif. 3 7, J 7 7 Lic. # 1219 Arch., Engr., Designer Address Tel. City I I Zip State Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing with Section 7000y t- of Division 3 of the Business and Professions Code, and my license is in full force and of fec 5*NATURE DATV OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from The Contractor's License Law for the fallowing reason: (Sec. 7031.5,&rsrress and Pngessi Code= Any city or roun(y which requres a permit to construct, alter, frrprevc, dvOxfth, or repair any structure, prior to Its issuance also requires the applicant far such Pernik to f9e a signed statement that ho Is Ucansad pursuant ro the provisions of the Contractor's LLcwsc Law, Chapter 9 (commencing mTh Section 70001 of Viosion 3 of the Burr� and Professions Code, or that he is exempt therefrom, and the basis far the alleged oxempbon. Any vkga?iun of Section 7031.E by 'any applicant far a permll subjacfs the applicant to a civil penaty of not mare than five hundred dolam fS5001. F.1 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, t3ulsness and Professions Cade' The ConkactKw s License Law does not apply to an owner of property Who bu*ft ar dnproma thereon and who does such work himself or throapth his own employees, prvvidod that such improvements are not intended at offered for sale. If, howevar, the budding Or knpravemenl m said whin one year of com101etion, the owner-buMnier wW have the burden of proving (hat he did not bidd or improve for the purpose of sate:) ❑ I, as owner of the property, am exclusively conlracting With licensed contractors to con- struct the project (Sac- 7044. Susoess and Professions Coca: The Contractors Llcensa Law does nor apply to an owner of property who bakft or improves thereon, and who contracts for such pinj6cls with a cuntracturfs) &canshd pursuant to the Confreclor's License Law.) ❑ 1 am exempt under Sec w. & 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 Inm,ranr oar or a c6rh-fled 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 fThfs section need not be completed ff the permit is for one hundred dollars ($100) valuation or fass.) I Cortify that in the performance of fig work for which this permit is issued, I !:tt=11 not employ any ppeerrssopn in any manner so as to become subject to the Workers' Compensation Laws of Calrfomia. Date Owner NOTICE TO APPLICANT_ IF, after making this Certificate of Exemption you should become subject to the Workers' Compensabon provisions of the Labor Code, you must forthwith comply with such provisions or this pennft shall he deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work For which this permit is issued- (Sec. 3097, Civil Code.) Lender's Name Lender's Address_ This is a building permit when properly filled out, signed and validated, and is subject to expiration if work thereunder is suspended for 18U days. I certify that I have read This application and state that the above information Is correct. I agree to comply with all city and county ordinances and state laws relating to building construction. and hereby authorize representatives of this city to enter the above- merittoned property for inspection purposes - Signature of applicant_ bath Mailing Address _ City, State, Zip An BUILDING: TYPE CONST. OCC. GRP. A.P. Number Pare T-I glli 1ta Legal 04937 Description P l ST; 1 C. 0 !4 - Tot 4 1 Sq. Ft. No. Size Stories No. Dw. Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation �y$ , 3,514 PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. r, Const. ,ry Mech. D rt Electrical L Plumbing 9 L -i : S.M.I. Grading Driveway Enc. Infrastructure TOTAL S 3 0 7 6 9 2 REMARKS 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- 1'' / 1fta Issued by: Date F Validated by: Validation: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SO. FT. a 2ND FL. SO. FT. @ POR. SO. FT. @ GAR. SO FT. a CARP. SO. FT. 0 WALL SO. FT. a SO. FT. @ ESTIMATED CONSTRUCTION VALUATION E UNITS YARD SPKLR SYSTEM MOBILEHOME SVC. BAR SINK POWER OUTLET ROOF DRAINS DRAINAGE PIPING DRINKING FOUNTAIN URINAL is 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(AUTONDISH) APPLIANCE DRYER GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED I LAUNDRY TRAY 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. a c BATH TUB SO. FT. a c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID a 11/4 c SEWAGE DISPOSAL SO.FT.GAR a 34c 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 OUND PLUMBINGZT 5) UNDERGROUND A.C. UNIT COLL. AREA SLAB GRADE --2, OUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMS SEWER OR SEPTIC TANK ROUGH WIRING DUCT WORK ROCKSTORAGE / FOUND. REINF./ 7I CCC A S (ROUGH) �m/ �d 9 /� (! d METER LOOP HEATING (FINAL) OTHER APPJEQUIP. REINF_ STEEL GAS (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM GRADING cu. yd. 5 plus x3 =$ LUMBER GR. FINAL INSP. /1 � /! FRAMING FINAL INSP. Q ROOFING 7 �Jrr C� T ��` / REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATIONISOUND 7 FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SEGNATURE&INITIALS GARDEN WALL FINAL