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04522 (SFD) IIIIIIIIIIIIIII 28 IIIIIIIIII ��I�f�'�V�� r' IE 04522 b .. P.O. BOX 1504 7&105 CALLE ESTADO - 'Building)' 79-'760 Arnold Palmer LA QUINTA,CALIFORNIA 92253 Address:. •' _ - ,Owner "• '_ ' dsunae Company BUILDING: TYPE CONST. OCC.GRP. AddreMailinss • 4 $� t'0" t — 'eke raitya` s + ��"��%� �C91XYS'� C`�.1.1�f �X'�t�t~: A.P.Number City, ,'+ Zip Tel. ' palm Tiesek't 32264 568-2R28 Legal Description Contractora. Project Description Plan FUR National 4sortgaga Address ' - Satm City Zip Tel. State Lic. City &Classif. Lic.# 398 Sq. Ft. 3038 No. No. Dw. Arch.,.Engr., Size Stories Units Designer New ❑ Add ❑ Alter❑ Repair ❑ Demolition ❑ Address I Tel. City.•' x Zip State Lic.# y 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 Professions Code,and my license is in full force and effect. --It .r' SIGNATURE DATE I OWNER-BUILDER DECLARATION Estimated Valuation I hereby affirm that I am exempt from the Contractors License Law for the following $217v204 reason: (Sec.',,703 1.5,Business and Professions Code: Any city or county which requires a permit to.construct, after, improve, demolish, or repair any structure, prior to its issuance also requires-the applicant for such permit to rile a signed statement that he is licensed pursuant to PERMIT AMOUNT the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of Division,30 Qhe Business and Professions Code, or that.he is exempt therefrom, and the 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 of not more than five hundred dollars($500). ❑I,as owner of the property,or my employees with wages as their sole compensation,will Plan Chk. Bal. $ 587.26 do the work;and the structure is not intended or offered for sale.(Sec. 7044,Buisness and Const. 728 0(} 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, Mech. 39.00 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 149.94 of proving that he did not build or improve for the purpose of sale.) �❑I,as owner of the property,am exclusively contracting with licensed contractors to con,• Plumbing 118.00 struct..,the:projedt. (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. �IR�`26 such projects with a contractor(s)licensed pursuant to the Contractor's License Law.) Grading ❑1 am exempt under Sec. B.&P.C.for this reason Driveway Enc. 'rpt,a�'a�r� rasrucure .1�„� Infttq4,987.09 Date Owner R mass Credit 2,443.55 WORKERS'COMPENSATION DECLARATION Net Infrastructure "�+��•� ..: ~ 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 r ❑Copy is filed with the city. ❑Certified copy is hereby furnished. TOTAL 4,a``1.01 Io - CERTIFICATE OF EXEMPTION FROM REMARKS " +i dYS, z•. WORKERS'COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars ($100) valuationyt.)��Ss .iNY At�tflliLt3-t� �'t4��i.r11 �� or less.) +•• I certify that in the performance of thg work for which this permit is issued,I shall not employ any parson in any manner so as to become subject to the Workers'Compensation Laws of California. r Date Owner NOTICE,TO APPLICANT., If, alter making this Certificate of Exemption you should become ZONE: BY: subject to the workers' Compensation provisions of the Labor Code, you must forthwith Minimum Setback Distances: comply with such provisions or this permit shall be deemed revoked. 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 this permit is issued.(Sec.3097,Civil Code.) Side Setback from Property Line Lender's Name Lender's Address INSPECTOR This-is a building permit when properly filled out,signed and validated,and is subject to FINAL DATE ECT expiration it work thereunder is suspended for 180 days. 3/1.7/80 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 of applicant Dale Mailing Address Validation: City, State, Zip r� y'., WHITE-FINANCE,PINK-APPLICANT,GREEN-BUILDING,GOLDENROD-ASSESSOR'S OFFICE,HARD COPY-FILE, CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES is• ., IST FL SO FT ip S UNITS 2ND FL SO FT.a YARD SPKLR SYSTEM POR SO FT * MOBILEHOME SVC. BAR SINK GAR SO.FT.Br POWER OUTLET ROOF DRAINS CAR P. SO FT.& DRAINAGE PIPING r WALL SO.FT.(d DRINKING FOUNTAIN SO.FT.fd URINAL ESTIMATED CONSTRUCTION VALUATION $ 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(AUTONDISHI APPLIANCE DRYER GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED 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. SO.FT.®c BATH TUB SO.FT, c WATER HEATER MAX.HEATER OUTPUT.B.T.U. SO.FT.RESID(g I'A c SEWAGE DISPOSAL SO.FT.GAR 3/4c HOUSE SEWER GAS PIPING PERMIT FEE PERM 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 8 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.IEOUIP. REINF.STEEL GAS(FINAL), TEMP.POLE GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM GRADING LUMBER GR. - FINAL INSP. cu.yd. FRAMING FINAL INSP. $ plus x$ _$ ROOFING REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR• GAR. FIREWALL LATHING MESH INSULATIONISOUND FINISH GRADING I N N CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL