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001710 (BLDG)_ 4 4Q" P.O. BOX 1504 Building 78-105 CALLE ESTADO Address 77-550 Czille trLA QUINTA, CALIFORNIA 92253 Owner Mailing Address L`�li. Boa- 1572 City Zip Tel. i.�� ~tiui ta 93923 :644-446 Contractor i,wAmwk i- i st. Cb. Address a Qlciinta 0 3 " 23 State Lic- City & Classif. 413636 Lic. # Arch., Engr., Designer Address Tel - City Zip State .,� Lic. # LICENSED CONTRACTOR'S DEC.L,9RATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Di,isio;i 3 of the Business and Professions Code, and my license is in full force and effect. §IGRATDHE _ 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 applicant lot such permit to Me a signed staNmenr that he Is kcensed pursuant to the provisions of the Contractor's Lfcense Law, Chaplet 9 (commencing with Saction 7000) of DW.&Ion 3 of the Business and Prolassivns Cade, or thathe 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). Cl I, de 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, Bussness and Professlons Code: The Contractor's License Law does nor 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 of completion, the owner -builder will have the burden 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- 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 contractors) licensed pursuant to the Contractor's License Law.) ❑ 1 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 ❑ 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 thg 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, after making this Certificate of Exemption you should become subject to the Workers' Compensation pmvlslons of the Labor Code, you must forthwith comply with such provisions or Ibis 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 certify that I have read this application and state that the above informatlon is correct I agrae 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. Signature of applicant Date --- Mailing Address City, State, Zip No. 001710 BUILDING: TYPE CONST. r� OCC. GRP. A.P. Number Legal Description Project Description - ' '.'3_13tA CA>lf YaIntenm3a f4aiirnr Sq. Ft. Ley z sJ No. No. Dw- Size r,^�r� Stories Units New fl Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. ►r 3 .+Ili Const. Mech. Electrical r- 15 Plumbing S.M.I- Grading 4-4. Driveway Enc. i - rSQ!1 .1n Infrastructure TOTAL :J 41), c9,7 Z 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: Late Permit Validated by:_ Validation: HARD COPY A 2 6 0 7 9 16 1899.47 U 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 - ESTIMATED CONSTRUCTION VALUATION $ UNITS YARD SPKLR SYSTEM MOBILEHOMESVC. 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 VENTSYSTEM 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, TEMIPERM LAVATORY HEATING SYSTEM FORCED GRAVITY AMPERES SERV ENT SHOWER BOILER B.T.U. SO. FT. ® c BATH TUB SQ. FT. ® c WATER HEATER MAX. I ICATER OUTPUT, B.T.U. SO. FT RESID 0 11/. r. SEWAGE DISPOSAI SQ.FT.GAR ® 3/ac HOUSE SEWER GAS PIPING FEE PERMIT FEE PERMITIT FEE rDBL 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./EQUIP. 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 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 SIGNAFURESfINtTIALS GARDEN WALL FINAL 4 4a Qum& P.O. BOX 1504 APPLICATION ONLY Building 78-105 CALLE ESTADO Address LA QUINTA, CALIFORNIA 92253 2 AL� BUILDING: TYPE CONST. OCC. GRP. A.P. Number. Mailing Address City Zip Tel. Legal Description Project Description Contractor Address City Zip Tel-,,,, State Lic. City & Classif. Lic. # Sq. Ft,.: No. No. Dw. -.5 4/1 Si Size Stories Units Arch., Engr., Designer New-4- Add El Alter El Repair 0 Demolition 0 Address.-,,`,,, f�2 Tel. City Zip State Lie. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 1=f.ctof Division 3 of the Business and Professions Code, and my license is in full force and ,,'Gt;ARJRF CAT 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 Us issuance also requires the appliawl for such permit to rile 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 1, 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, pro I s the building provided that such improvements are not intended or offered for sale. If, however, or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he did not build or improve for the purpose of sale.) Estimated Valuation PERMIT AMOUNT Plan Chk. Dep. vG Plan Chk. Bal. Ar— Const.- Mech. Electrical Plumbing 0 1, 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 contraclor(s) licensed pursuant to the Contractor's License Law.) I am exempt under Sec. B. & P.C. for this reason S.M.1- Grading Driveway Enc. DateOwnerInfrastructure 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 0 Copy is filed with the city. 0 Certified copy is hereby furnished. TOTAL CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE REMARKS (This section need not be completed if the permit is for one hundred dollars ($100) valuation or less.) I C�rijy that in the performance of thp work for which this permit is issued, I shall not employ yrson in any manner so as to become subject to the Workers' Compensation Laws of any romia. Date -Owner NOTICE TO APPLICANT. If, after making this Certificate of Exemption 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. ZONE: BY: Minimum Setback Distances: Front Setback from Center Lin Rear Setback from Rear Prop. Line CONSTRUCTION LENDING AGENCY Side Street Setback from Center Line I hereby affirm that that 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 Nam FINAL DATE INSPECTOR Issued by: DatePermitI Validated by: Lender's Address 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. agree to comply with all city and county ordinances and state laws relaling to building construction, and hereby authorize reprosonlatives Hof this city to enter the above - mentioned prop" for Inspection purposes. Signature of applicant Date Mailing Address Validation: A 1 7 5 5 6 2 6 City, State, Zlp BUILDING DIVISION + UNDE�GR C1N0 TA nil < 7-RIM ADR GASDZ I A/E W17H Sv C T70AI ,avMp �• pOVBL c WALL ' AAe:k �• 53 PM /'/Z•' AALL, FLogr vALvE 3. 13 - I'll" vl;.vr CAA '�. 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