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002416 (SOTB)4 4 " P.O. BOX 1504 No. 0 0 2 4 1 6 Building5` fir' Hill 78-105 CALLE ESTADO Address LA QUINTA, CALIFORNIA 92253 Owner BUILDING: TYPE CONST. OCC. GRP, Mailing Address 75-005 Club IBX. A.P. Number City Zip Tel. ,. 92264 - Legal Description Project Description �% '_'' 4 Contractor1s8 _ Address'.,�G. ii2 city Zip Tel. State Lic. City & Classif. 21381.'30- Lic. # 3?` S Ft. SQ�� '� e f i.No. No. Dw. 'Stories Units Arch., Engr., Designer New I] Add ❑ Alter ❑ Repair ❑ Demolition ❑ Address Tel. City Zip 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 Processions Code, and my license is in full force and effect. SIBNAitJRP IiAiE OWNER -BUILDER DECLARATION wT I hereby affirm that I am exempt from the Contractor's License Law for the following reason: (Sec. 7031. S,Business and Professions Code: Any city or county which requires a permit to construct, alter, improve; demolish, or repair any structure, prior to its issuance also requires the appflcant for such,pemrit to Me a signed statement that he is licensed pursuenf to `haprevisions of the Contractor's Llcortse Law, Chapler 9 (cammencing with Section 7000) of ❑Ivi4 3 of the Business and Profassiona Cody, or that he Is oxempt rherefrom, add the basis for 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 five hundred dollars (8500). ❑ 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 builds or improves thereon and who does such work himself 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 a. 7 4� ! ■ V PERMIT AMOUNT Plan Chk. Dep: Plan Chk. Bal. �O.l Const.' [{7 ■ t.: Mech. Electrical Plumbing ❑ I, as owner of the property, am exclusively contracting with licensed contractors to con- struct the project. (Sec. 7044, Business and Proles$lons 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, ti: P.C. for this reason S.M.I. Grad i ray 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. TOTAL CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE REMARKS (This section need not be completed if the permit is for one hundred dollars (8100) valuation or less.) I certify that in the performance of the 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 CertiYrcare of Exemption you should become subject to the Workers' Compensation provistons of the Labor Code, you must forthwith comply with such provisions or thla permit shall be deemed 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 FINAL DATE INSPECTOR 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 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 ordlnances and state laws relating to building oDnstructlon, and hereby authorize representatives of this city to enter the above- mentioned property for inspection purposes. Issued by: Validated by: Date Permit Signature of applJcani Date Marlins Address Validation: A 5 8 1 3 6 17 1 53,43 CK City, Stale, ZIP HARD COPY CONSTRUCTION ESTIMATE GROUND PLUMBING NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SQ. FT. ® $ 2ND FL. SQ. FT. @ POR. SQ. FT. ® GAR. SQ. FT. ® CAR P. SQ. FT. WALLSQ. FT. SQ. FT. ® ESTIMATED CONSTRUCTION VALUATION $ SLAB GRADE UNITS BONDING HEATING (ROUGH) YARD SPKLR SYSTEM MOBILEHOME SVC. BAR SINK POWER OUTLET ROOF DRAINS ROCK STORAGE DRAINAGE PIPING GAS (ROUGH) DRINKING FOUNTAIN HEATING (FINAL) URINAL REINF. STEEL WATER PIPING NOTE: Not to be used as property tax valuation FLOOR DRAIN MECHANICAL FEES SERVICE FINAL INSP WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD WATER SYSTEM FINAL INSP. SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER LUMBER GR. FRAMING ROOFING GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED FIREPLACE SPARK ARRESTOR LAUNDRYTRAY AIR HANDLING UNIT CFM MESH INSULATION/SOUND KITCHEN SINK ABSORPTION SYSTEM B.T.U. CERT. OCC. TEMP USE PERMIT SVC WATER CLOSET COMPRESSOR HP POLE, TEM/PERM 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 ® 11/4 c SEWAGE DISPOSAL SQ.FT.GAR p 3/4C 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 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 FINAL INSP. FINAL INSP. GRADING cu. yd. $ plus x$ REMARKS: =$ LUMBER GR. FRAMING ROOFING VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATION/SOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL