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04318 (BLCK)T4bf 4 44P (2" P.O. BOX 1504 Buildings--",i 4'itilil�Tl�7vid' 78-105 CALLE ESTADO Address LA QUINTA, CALIFORNIA 92253 Owner t al )Amt f„�.matruc pion BUILDING: TYPE CONST. OCC. GRP. Mailing Address 74---)90 Velia Way A.P. Number City Zip Tel. 'tx�:^ 3 fr3tie3XG9 22160 346- 8^-• Legal Description Contractor Project Description 1 v 0 ' X 31 re ai nin`q - is 11 Game 1 P Address City Zip Tel. State Lic. 3 5 3 739 City & Classif. Lic. # Sq. Ft. No. No. Dw. Size Stories Units Arch., Engr., Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Address Tel. City Zip State Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under prevviian; of Chapter 9 (commencing with Section 7000} of ❑ivis€on 3 of the Business and Professions Code, and my license is in full force and effect. SlGNATt1RE _ hATE OWNER -BUILDER DECLARATION Estimated Valuation I hereby affirm that I am exempt from the Contractor's License Law for the fallowing reason: (Sec. 7031.5,Buslness 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 rho applicanr 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 therefrom, and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit Plan Chk. Oep, subjects the applicant to a civil penalty of not more than five hundred dollars ($500). ❑ 1, 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 of for sale. (Sec. 7044, Bussness and COnst. Professlans Code: The Conlractor's License taw doas not apply to an awnar or 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-bullder 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. 70-(4, Business and Professions Code: The Contractor's License Law does nor apply to an owner of property who builds or Improves thereon, and who Confracfs for S.M.I. such projects with a contractor(s) licensed pursuant to the Contractor's License Law-) Grading ❑ 1 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 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 thg work for which this permit is issued, I shall not employ any pparson in any manner so as to become subject to the Workers' Compensation Laws of Califarnla. Date Owner 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 Lender's Address - FINAL DATE INSPECTOR 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. Issued by: Date Permit I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorlxe representatives -of this city to enter theabove- men t I onLd property for Inspectlon purposes. Validated by: Signature of applicant Date Mailing Address Validation: City, State, Zlp WHITE - FINANCE, PINK - APPLICANT, GREEN - BUILDING, GOLDENROD - ASSESSOR'S OFFICE, HARD COPY - FILE CONSTRUCTION ESTIMATE NO ELECTRICAL FEES NO PLUMBING FEES 1ST FL SO Fl Ip 2ND FL SO FT � POR SO FT Qr GAR SO FT (t- CAR P SO FT 6 WALL SO FT a SO FT fd ESTIMATED CONSTRUCTION VALUATION S UNITS YARD SPKLR SYSTEM MOBILEHOME SVC BAR SINK POWER OUTLET ROOF DRAINS 1 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)(DISHI APPLIANCE DRYER GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED LAUNDRYTRAY AIR HANDLING UNIT CFM IKITCHEN SINK ABSORPTION SYSTEM B.T.0 TEMP USE PERMIT SVC WATER CLOSET COMPRESSOR HP POLE,TEMIPERM LAVATORY HEATING SYSTEM cnRCcn SRAWITY f &M13CRES SERY ENT SI-IOWEP BOILER B.T.U. SO. FT ® c BATH TUB SO FT. ® c WATER HEATER MAX HEATER OUTPUT, B T U SO FT RESID 11A c SEWAGE DISPOSAL SO FT.GAR rg J/� c 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.0 UNIT COLL. AREA SLAB GRADE ROUGH PLUMB BONDING HEATING (ROUGH) STORAGE TANK FORMS SEWER OR SEPTIC TANK ROUGH WIRING DUCT WO(1K HEATING (FINAL) ROCK STORAGE OTHER APP.IEOUIP FOUND REINF GAS (ROUGH) METER LOOP REINF. STEEL GAS (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE FINAL INSP BOND BEAM WATER SYSTEM GRADING cu yd. $ plus xS =S LUMBER GR FINAL INSP FRAMING FINAL INSP. ROOFING REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATIONISOUND FINISH GRADING FINAL INSPECTION CERT, OCC FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL d.