The URL can be used to link to this page

04692 (SFD)Twlvl 4 44�a" P.O. BOX 1504 Building.78-105 CALLE ESTADO Address- ,93'-965 Cortex LA QUINTA, CALIFORNIA 92253 Owner Coachella Valley Mailing Address � 7 Tnznz v l ;e City Zip Tel. Contractor J Address City Izip State Lic. City+, & Classif. Lic. # Arch., Engr., Designer Address Tel. City I Zip I State J 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 Professions Code, and my license is in full force and effect. .§IGNATURE DATE OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason: (Sec. 7031.5,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 applcant for such permit to file a signed statement that he is licensed pursuant to 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 subjects the applicant to a civil penalty of not more than five hundred dollars ($500)- 0 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 or completion, the owner -builder will have the burden of proving that he did not build or improve for the purpose of sale.) E-1 I, as owner of the property, am exclusively contracting with licensed contractors to con- struct the project, (Sec. 7044, Business and Professions Cade: The Contractor's License Law does not apply to an owner of property who builds or Impraves thereon, and who confracts. for such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) ❑ I am exempt under Sec. B. R 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 thareof. (Sec. 3800, Labor Code ) Policy NCompany — ❑ Copy is filed with the city. ❑ 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 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: 11, aher making this CtFa tcale of Exemption you should become subject to the Workers' Compensation provfsforns of the Labor Cade, you must forthwith comply with such provisions er this parrrNYshatl 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 certify 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 slate laws relating to building construction, and hereby authorize representatives -of this city to enter the above - mentioned property far inspection purposes. Signature of applicant Date BUILDING: TYPE CONST. OCC. GRP A.P. Number Legal Description Project Description Sq. Ft. 1409 No. No. Dw. Size Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ 4301 61 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 Valirfatar1 hV' Validation: Mailing Addres City, State, Zi WHITE - FINANCE, PINK - APPLICANT, GREEN - BUILDING, GOLDENROD - ASSESSOR'S OFFICE, HARD COPY - FILE CONSTRUCTION ESTIMATE NO ELECTRICAL FEES NO PLUMBING FEES tST FL SO FT y 2ND FL SO FT POR SO FT or GAR SO FT a CARP gp F7 q WALL SO FT (d SO FT rB 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 lax valuation FLOOR DRAIN MECHANICAL FEES WATER SOFTENER VENT SYSTEM FAN EVAP.000L HOOD SIGN WASH ER(AUTONDISH) APPLIANCE DRYER GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED LAUNDRYTRAY AIR HANDLING UNIT CFM KITCHEN SINK ABSORPTION SYSTEM B T.0 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 SO FT a c WATER HEATER MAX HEATER OUTPUT, B T U SO. FT. RESID g 1 v: c SEWAGE DISPOSAL SO FT GAR Ca 3/4c HOUSE SEWER GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE DEL TOTAL FEES MICRO FEE MECH FEE PL.CK PEE CONST FEE ELECT. FEE SMI FEE PLUMB FEE STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND SOLAR ,,' SETBACK '''-_ G !/JGROUND PLUM BIN�/-7 ,�f UNDERGROUND BONDING A.C. UNIT HEATING (ROUGH) COLL. AREA STORAGE TANK !`(SLAB GRADE 1 + .. ROUGH PLUMB 0SEWEH FORMS OR SEPT A 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 cu yd $ plus xS =$ LUMBER GR FINAL INSP .IeRAMING � r � �'� FINAL INSP. OOFING 6'lJL�� VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR FIREWALL LATHING ol/� G-,� lJ`�/.� - s- I / rJ,, \ 1 �a .�'r- REMARKS: MESH 2LiJNSULATION/SOUND' FINISH GRADING J FINAL INSPECTION CERT OCC FENCE FINAL GARDEN WALL FINAL rG VA