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003570 (PLBG)T4`1v1 4 4 Qubtz P.O. BOX1504 No.�� Building ��--q'�a r,�Y. 78-105CALLEESTADO Address ���-ut' LA QUINTA, CALIFORNIA 92253 Owner Mailing BUILDING: TYPE CONST. OCC. GRP. Address A.P. Number City Zip Tel. Legal Description Contractor Project Description Address 58--415 Porev City 4Zip Tel, State Lic. City & Classif. F . .� Lic. # - , ., Sq. Ft. No. No. Dw. Arch., Engr., Size Stories Units Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Address Tel. City Zip State Lic. # LICENSED CONTRACTOR'S DECLARATION I heretly affirm that I am' licensed under provisions of Chapter 9 (commencing with Section 701X1} of Elivision 3 of •the Business and Professions Code, and my license is in full force and effect. SIGNATl1Rr OWNER -BUILDER DECLARATION Estimated Valuation r': -. I hereby affirm that I am exempt from the Contractor's License Law for She following reason; (Sec. 7031.5,8uskPOvs arnl Prolesslons Cade: Any city or county which requires a permlr to construct, alter, imptove, demolish, or repair any structure, prior Io ifs i=uanca also requires the appliCard for such permit to rile a sitmed statement thal he is licensed pursuant to PERMIT AMOUNT rho provisions of the Contractor's License Law, Chapter 9 jcoam;enc46rg wlfh Section 7000) of llw&on 3 of the Business and Professions Code, or Thal. he Is exempt Mwefrom, and the basis for the alleged exemplx3p. Any violation of Section 7031.5 by any appliicanr for a perm# Plan Chk. Deli. subjects the applicant to'a 60 penalty of not more than love hundred dollars (SSOO). ❑ I, as owner of the property, or my employees with wages as their sole compensation, will Plan Chk. Bal. do the work, and the structure is not intended or offered for sale. (Sec. 7044. Bussness and COnst. 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. 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 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 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 S.M.I. such projects with a contractor(s) licensed pursuant to the Contractor's License Law-) Grading ❑ I am exempt under Sec. B. & P.C. for this reason _ 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 REMARKS 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 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: If, aRer 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 FINAL DATE INSPECTOR This is a building permit when properly filled out, signed and validated, and is subject to p expiration if work thereunder is suspended for 180 days. I certify that I have read thls application and state that the above informatl.on is correct Issued by: Date Permit I agree to comply with all elty and county ordinances and .state laws relating to building construction, and hereby authorize representatives of this City to enter the above- mentloned property for inspection purposes. Validated by Signature of applicant Date Mailing Address Validation: City, State, Zip HARD COPY P.O. BOX 1504 No: �� Address Building 49-473 Gui faro LA QUINOTACL CALIFORNIA 92253 Owner 'lSet1 Mailing BUILDING:. TYPE CONST. OCC. GRP. - - Address A.P. Number City Zip Tel. Legal Description Contractor Project Description Seder F3i3ok u Econ -o Sewer Service Address 69-415 Perev_ F oaa City Zip Tel.- Cathedra i C��' t -:346-2793_ - State Lic. City' & Classif. 480962 Lic. # 342 Sq. Ft. No. No. Dw. Arch., Engr.; Size Stories - Units ' - - - -- Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Address Tel. City Zip State Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm t�l amNicensed under provisions of Chapter 9 (commencing with Section 7000) of Divis_ ion3 ofIthe Business and Professions, Code, and my license its in full force a d effect. ,� �� = SIGNATURE DATE • OWNER -BUILDER DECLARATION Estimated Valuation I hereby affir>�m that I am exempt from the Contractor's License Law for the following ��a �^0 reason: (Sec. 7031.5,Businhss 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 applicant.for such permit to file 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 3 of the Business and Professions Code, or that -he is exempt'theiefrom, 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). Plan Chk• Bal. ❑ 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 Const. t"�?(7! A(�� 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. 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 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 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 - S•M•I• such projects with -a contractor(s) licensed pursuant to the Contractor's License Law.) Grading O I am exempt under Sec. B. 8 P.C. for this reason 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.- f~•�+✓.a.cx _ <-.43 '7C, , sAA { A ._ns f _ TOTAL s, CERTIFICATE OF EXEMPTION FROM REMARKS 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 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 Ownei NOTICE TO APPLICANT. If, after 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 Lenders Address FINAL DATE INSPECTOR 'This is a building permit when properly filled out, signed and validated, and.is subject to - expiration it work thereunder is suspended for 180 days. 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 _ Date Mailing Address Validation: City, State, Zip HARD COPY T ' CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SQ. FT. ® 2ND FL. SQ. FT. POR. SQ. FT. ® GAR, SQ. FT. ® CAR P. SQ. FT. WALL SQ, FT. SQ. FT. g ESTIMATED CONSTRUCTION VALUATION $ UNITS YARD SPKLR SYSTEM MOBILEHOME SVC. BAR SINK POWER OUTLET ROOF DRAINS DRAINAGE PIPING DRINKING FOUNTAIN URINAL $ 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(AUTO)(DISH) 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,TEM/PERM LAVATORY HEATING SYSTEM FORCED GRAVITY AMPERES SERV ENT SHOWER BOILER B.T.U. SO. FT. ® c BATH TUB SQ. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SQ. FT. RESID ® 11/4 c SEWAGE DISPOSAL SQ.FT.GAR ® 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 GRADING cu. yd. $ plus x$ _$ LUMBER GR. FINAL INSP. FRAMING v i bINAL INSP/V O/ �'� n rffrr ! 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 SIGNATURESIINITIALS GARDEN WALL FINAL