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10678 (PLBG)T4t�t 4 aCP Qum Building AddressJ , Plan Chk. Dep. Owner Plan Chk. Bal. Const. y Mech. Mailing Electrical Address S.M.I. City Grading Zip Tel. Infrastructure Contractor Address L° > ;` 3". REMARKS City Zip Tela 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 Issued by: Date Permit Validated by: Validation: ti 362 J State Lie. City & Classif. Lie. # Arch., Engr., Designer Address I Tel. CityI Zip I State Lie. # P.O. BOX 1504 78-105 CALLE ESTADO LA QUINTA, CALIFORNIA 92253 LICENSED CONTRACTOR'S DECLARATION 1 herehy affirm that I am sicenend under provinlon5 of Chapter 9 (commencing with Section 7DDDj of Division 3 of the Business and Professions Code, and my license is in full force and effQct. • NATURE DATE OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law tar the following reason: (Sec. 7031.5,Businass aid Professions Code: Any city or county which regWres a permit to Construct, after, Improvo, domaAsh, or repair any structure, prior to its issuance also regattas the app7Jcsnf for such permit to Ida a sfgnod stafemerrl that he is ticensed pursuant to the provisions of the Contractor's License Low, Chanter 9 (commencing wkh Section 7000) of olvhdon 3 of the Buskrass and Profess urs Code, or that, he is exempt thentimm, and the basis for tha apaged exempfficm Any vlalallorr of Section 7031.5 by 'any appffconl for a parmrT sub)ects the applicant to a clvd penatly of not more than five hundred doAu,5 (3500)- D 1, as owner of the property, or my employees with wages as their sole compensetlon, will do the work, and the structure is not Intended or offered for sale- (Sec. 7044, Buisness and Professions Code: The Contractor's Llcanse Law dues oaf apply to an owner of property who bullas at irnproves thereon and who does such work hlmsall or through his own employees, Provided that such improvements are not intended or offered for sate. If, however, the bulld0p or Improvement is sold w4ho one year of complellm. the owner -builder wRf have the burden of proving that he did not build or improve for the purpose of sale.) D 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.) O I am exempt under Sec. B. & 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 Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.) Policy No Company — Ll •0opy Is filed With the city. D Certified copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM 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 thg work for which this permit is issued, I shall not emptay any parson in any manner so as to become subject to the Workers' Compensation Laws of Cali omia. Date—Owner NOTICE TO APPLICANT. fir, after making this Certificate of Exvmp!r,n you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be 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 180 days. I certi{y 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 reiating to building construction, and hereby authorize representatives sof this city to enter the above- mentioned property for Inspection purposes. Signature of applicant Date Mailing Addros City, State, Zip No. 10678 BUILDING: TYPE CONST. OCC. GRP. A.P. Number Legal Description Project Description Sq. Ft. No. No. Dw. Size Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. Const. Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure TOTAL 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 Issued by: Date Permit Validated by: Validation: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SO. FT. ® $ 2ND FL. SQ. FT. POR. SQ. FT. GAR. SO. FT. ® CAR P. SO. FT. @ WALL SQ. FT. ® SO. FT. @ ESTIMATED CONSTRUCTION VALUATION Is UNITS IMOBILEHOME SVC. POWER OUTLET SLAB GRADE YARD SPKLR SYSTEM BAR SINK ROOF DRAINS DRAINAGE PIPING DRINKING FOUNTAIN URINAL WATER PIPING NOTE: Not to be used as property tax valuation ROCKSTORAGE FLOOR DRAIN MECHANICAL FEES METER LOOP WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD :SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED WATER HEATER LAUNDRYTRAY 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. SO. FT. RESID ® 11/4 c ISEWAGE DISPOSAL VENTILATION SQ.FT.GAR ® 3/ic HOUSE SEWER FIRE ZONE ROOFING 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 ROCKSTORAGE FOUND. REINF. GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APP./EQUIP. REIN F. STEEL n GAS (FINAL) l / P ` 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 do zo ..... .. .. ;; loo� -flIA- i