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07131 (MFD5)Building Address 78-337 Scarlet Court Boulevard Development P.O. BOX 1504 78-105 CALLE ESTADO LA QUINTA, CALIFORNIA 92253 Mailin Address 777 S. Main St. Suite 106 City Zip Tel. Orange CA 92686 724-547-8356 Contractor City State Lic. I City & Classif.461814 Lic. # Designer Address silty IZip I 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. �� _._.�, '�..�..._�"j ,1.✓ ,,,/ �—• _SIGNATURE "' K. DATE Z/ OWNEWBUILOER DECLARATION 1 hereby affirm that 1 am exempt from the Contractor's License Law for the following reason: (Sec. 7031.5,13siress and Professions Code: Any city or county which requires a permit to construct, after, improve, demolsh, or repair any structure, prior to its issuance also requires the applicant for such permit to life 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 civilpenally of not more than five hundred dollars ($500). ❑ 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 i provemerds are not intended or offered for sale. If, however, the building or improvement is sold wBltit one year of completion. the owner -budder will have the burden of proving that he did not Ladd or improve for the purpose of sale.) O 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 contractorfs) licensedpursnant to the Contractor's License Law.) ❑ I am exempt under Sec. R, & P.C. for this reason Date Owner WORKERS' COMPENSATION* DECLARATION .. I hereby affirm that 1 have a certificate of consent to self -insure, ora certificate of Worker's Compensation Insurance, ora certified'copy thereof (Sec.,3800, Labor Code.), Policy No. Company \ . ,.r.r; ira/ i/r;%� O Copy is filed with the city- ❑ CrffieA copy he eby fumished. CERTIFICATE OF EXEMPTION FROM WORKERS'COYPENSATIONINSURANCE (This section need not be conrfdWed ff 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: d, after making this Cerfifrate of Exemption you should become subject to the Workers' Compensation provisions at the Labor Code, you must forthwith comply with such Provisions or Otis permit shalf 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 - Lenders 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. 1 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 Signature of appi Mailing Address. City, State, Zip_ No. BUILDING: TYPE CONST. OCC: GRP. A.P. Number 613-790-013 ©7131 OLDLegal Description #25 Wit #245 Project Description Plan 1 Sq. Ft. 9Z�j No. No. Dw. Size Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Garage included Estimated Valuation $x66,732 PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. it319M Const. 49i Do Mech.. Electrical t3 Plumbing S.M.I. 4.6 Grading Driveway Enc. Infrastructure 1 s T1 IR 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 I SR!F 00 Issued by: Date ! Permit Validated by: Validation: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SQ. FT. ® $ UNITS A.C. UNIT COLL AREA SLAB GRADE YARD SPKLR SYSTEM 2ND FL. SQ. FT. BONDING HEATING (ROUGH) MOBILEHOME SVC. BAR SINK POR. SQ. FT. ® SEWER OR SEPTIC TANK ROUGH WIRING GAR. SO. FT. ® POWER OUTLET ROOF DRAINS FOUND. REINF. ¢ DRAINAGE PIPING CAR P. I SO. FT. ® HEATING (FINAL) WALL SQ. FT. ® REINF. STEEL DRINKING FOUNTAIN GAS (FINAL) TEMP. POLE URINAL SQ FT ® GROUT ESTIMATED CONSTRUCTION VALUATION $ WATER HEATER WATER PIPING NOTE: Not to be used as property tax valuation FINAL INSP. FLOOR DRAIN MECHANICAL FEES WATER SOFTENER VENT SYSTEM FAN EVAP.000L HOOD SIGN WASHER(AUTOXDISH) APPLIANCE DRYER LUMBER GR. GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED FRAMING l d LAUNDRY TRAY AIR HANDLING UNIT CFM ROOFING 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. SQ. FT. ® c BATH TUB SQ. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SQ. FT. RESID ® 11A c SEWAGE DISPOSAL SPARK ARRESTOR SQ.FT.GAR ® 3Ac HOUSE SEWER GAR. FIREWALL 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 ev ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMS SEWER OR SEPTIC TANK ROUGH WIRING DUCT WORK ROCKSTORAGE FOUND. REINF. ¢ GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APPJEQUIP. REINF. STEEL GAS (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM GRADING --yd. $ plus x$ =S LUMBER GR. FINAL INSP. FRAMING l d FINAL INSP. ROOFING Q� REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL p G -, 4 MESH INSULATION/SOUND-?/ q 0 IL l FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURES/INITIALS ' GARDEN WALL FINAL