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003895 (BLCK)44 P.O. BOX 1504 Building78-105 CALLE ESTADO Address 51-251 0$ rogron LA QUINTA, CALIFORNIA 92253 ' Owner Mailing Address P. ©_ Box 151 City lZip ITel. Contractor fitz0lac Address . jZip Tel. State Lic. City & Classif... Lic. # Arch., Engr.,' Designer Address Tel. City Zip State - 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. SIGNATURE 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 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 or 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'clvil penalty'of not more than rive hundred dollars ($500). . O 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 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 contractor(s) licensed pursuant to the Contractor's License Law.) 0 1 am exempt under Sec..B. B. & P.C. for this reason 41 /1 .rf, 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 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, 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. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit 1s 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 state laws relating to building construction, and hereby authorize representatives sof this city to enter the above-: mentioned property for inspection purposes. Signature of applicant Date Mailing Address City, State, Zip HARD COPYI It1 Mv �, BUILDING: TYPE CONST. OCC: GRP. A,P..Number 773-051-016 Legal Description Project• Description °-14newl ' ramp- stnislr_cl A r'eh Sq. Ft. No. No. Dw. Size Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation $110,00 PERMIT .' AMOUNT Plan 'Chk. Dep. ... Plan Chk_. Bal. Const. 41t1 fir, .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: Date4/.27/8Permit Validated by: Validation: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FrcES., IST FL. SQ. FT. ® $ 2ND FL. SQ. FT. POR. SQ. FT. @ GAR. SO, FT. ® CAR P. SQ. FT. WALL SQ. Fr. ® SO. FT. ® ESTIMATED CONSTRUCTION VALUATION $ UNITS MOBILEHOME SVC. POWER OUTLET YARD SPKLR SYSTEM BAR SINK ROOF DRAINS DRAINAGE PIPING DRINKING FOUNTAIN URINAL WATER PIPING NOTE: Not to be used as property tax valuation BONDING FLOOR DRAIN MECHANICAL FEES FORMS WATER SOFTENER VENT SYSTEM FAN EVAP.000L HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER GAS (ROUGH) GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED OTHER APP.IEQUIP. LAUNDRY TRAY AIR HANDLING UNIT CFM TEMP. POLE 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. SQ. FT. ® c BATH TUB SQ. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 11/4 c SEWAGE DISPOSAL SQ.Ff.GAR ® 3/ac HOUSE. SEWER REMARKS: 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 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 I NSYtU 1 UK'b WUNA I UKLWINl 1 IALJ, GARDEN WALL FINAL --- D �� //�I/ .. _._.�.,.1 .... .. .. ---