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002842 (RPL)T4tyl 4 CQ P.O. BOX 1504 No. 002842 Building 78-105 CALLE ESTADO Address -54'-"5 'aft Hili LA QUINTA, CALIFORNIA 92253 Owner BUILDING: TYPE CONST. OCC. GRP, Mailing Address 'jt_y i�i�:t' ! ;�*� !, Y,7: A.P. Number City Zip Tel. 710-L-1. i 9220 Legal Description Project Description `��`�' Cvntraatar G.E. Fool r"�')�+nl't Address n� City Zip Tel. Ca} 4 71 State Lic. City & Classif.����� Lic. # t Sq. Ft. Size No. No. Dw. Stories Units Arch., Engr., New 4 Add ❑ Alter ❑ Repair ❑ Demolition ❑ Designer Address Tel. City Zip State Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Secti 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. *IGNAIFUFir PAT - OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's license Law for the following Estimated Valuation reason: (Sec. 7031.5,Business and Professions Made: Any clly or county which requires a permit to construct, after, improve, demolish, or repair arty sfruclufe, prior to its issuance also feQuires 1ha applicant for such permil to Pie a signed statement that he is licensed pursuant to the provisions of the Cortlractor's License Law, Chapter 9 (cbmmen;FnV with Section 7000) of PERMIT AMOUNT OlvWon 3 of the Business and Professbns Cade, or that he is eitampt therefrom, and the basis fbr tho alleged exemption. Any violation of Section 7031.5 by any appycnnl for a permit subjects the applicant to a civil penafty of not more than rve hundred dollars (5500). ❑ 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 of property who Plan Chk. Dep. Plan Chk. Bal. Const. Mech. 25.00 builds or improves thereon and who does such work himself or through his own employees, provided that such Impiovements are not intended or offered for sale. If, however, the building Electrical �� •` • , e •'% or improvement is said withrn one year of compietion, the owner -builder will have the burden of proving that he did not build or improve for the purpose of sale.) Plumbing ❑ 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 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. & P.C. for this reason S.M.I. 1.37 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, ora certified copy thereof. (Sec. 3800, Labor Code.) Policy No. — Company ❑ Copy is filed with the city. ❑ Certified copy is hereby furnished. TOTAL CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE REMARKS f (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 employany person in any manner so as to become subject to the Workers' Compensation Laws of California. Date Owner NOTICE TO APPLICANT: Il, after making this Certlficata of Exemption you should become subject to the workers' compensation pravisions or the tabor Code, you must forthwith comply with such provisions or fhls pemtlt shall be deemad revoked. ZONE: BY: Minimum Setback Distances: Front Setback from Center Line 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.) Side Street Setback from Center Line Side Setback from Property Line Lender's Name Lender's Address FINAL DATE Issued by: Validated by: INSPECTOR Date 4 ~ `"1 Permit This is a building permit when properly filled out, signed and validated, and is subject to expiration if work thereunder is suspended for 180 days. I certify that l 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 sof this city to enter the above- mentioned property for Inspection purposes. Signature of applicant Date Mailing Address Validation: City, State, Zip A712% 1 16 29u19 �K HARD COPY CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SQ. FT. ® $ UNITS SLAB GRADE ROUGH PLUMB. BONDING YARD SPKLR SYSTEM 2ND FL. SQ. FT. © FORMS SEWER OR SEPTIC TANK ROUGH WIRING MOBILEHOME SVC. BAR SINK POR. SQ. FT. ® GAS (ROUGH) METER LOOP HEATING (FINAL) POWER OUTLET ROOF DRAINS GAR. SQ. FT. ® TEMP. POLE GROUT DRAINAGE PIPING CAR P. SQ. FT. ® FINAL INSP. BOND BEAM WATER SYSTEM DRINKING FOUNTAIN WALL SQ. FT. ® LUMBER GR. FINAL INSP. URINAL SQ. FT. ROOFING ESTIMATED CONSTRUCTION VALUATION $ WATER PIPING NOTE: Not to be used as property tax valuation FLOOR DRAIN MECHANICAL FEES VENTILATION WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER FIREPLACE GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED 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. SQ. FT. ® c BATH TUB SO. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SQ. FT. RESID ® 1114 c SEWAGE DISPOSAL SQ.FT.GAR ® 3/4c HOUSE SEWER CERT. OCC. GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE DBL IOIAL FELS MK:HU FEE MEUH.FEE NL.CK.FEE CONST. FEE ELECT. FEE SMI FCe PLUMS. FFP 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./EQUIP. REINF. STEEL GAS (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM GRADING cu. yd. III $ 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 SIGNATt1RCS7I NITIALS GARDEN WALL FINAL 7d