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ELEC (002852)56999 Madison St 002852 Building ' 56-999 FWLSW AVP-., Address City Owner State... Mailing _ Address P10. BM 1000 City . " LICENSED CONTRACTOR'S DECLARATION Zip La eta .922533., 522 .- Contractor Contractor Grading E r OWNER -BUILDER DECLARATION 1 hereby affirm that 1 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, atter, 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 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)! ' -•— ❑ 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.ot property who ibm t .9irtue::tm Address . - - PERMIT - City Sam State Lic. & Classif.. 41363 Arch., Engr.,- Designer 4 P.O. BOX 1504 NQ.. 002852 78-105 CALLE ESTADO LA QUINTA, CALIFORNIA 92253 BUILDING: TYPE CONST. OCC: GRP. A.P. Number Tel. 564®4463 Legal Description Project Description I Lic. # 133 Sq. Ft. No. No. Dw. Size - Stories Units New [J. Add ❑ • Alter ❑' Repair ❑ Demolition ❑ Address . Tel. : ,} - City Zlp State... 3ie' _ - t Lie. # *ri . " LICENSED CONTRACTOR'S DECLARATION r•• I hereby affirm that I am licensed under provisions iif Chapter 9 (commencing with Section- , ' 7000) t.of Division 3 of the Business and Professifons Code', and my license is in full force and effec. SIGNATURE DATE Grading E r OWNER -BUILDER DECLARATION 1 hereby affirm that 1 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, atter, 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 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)! ' -•— ❑ 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.ot property who _ Estimated Valuation ' - - PERMIT - Plan.Chk. Dep. - Plan Chk. Bal. " COr16t.. '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 ' "Mach. ' Ln for a reswt 3 . px&p' tion L AMOUNT or improvement is sold within one year of completion, the•owner-bwlderr.wUl have the burden of proving that he did not build or improve for the purpose of sale.). - - EIQCtfICal : ,} - ❑ I, as owner of the property, am exclusively contracting with licensed contractors to con. Plumbing r 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 S' -M.1. ' - such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) Grading ❑ lam-exempt.under Sec. -B. ti. 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 , Workers 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 35.0 CERTIFICATE OF EXEMPTION FROM REMARKS, WORKERS' COMPENSATION INSURANCE (This section need not be, completed it 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-Fein 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 'Compensation ZONE: BY: subject to the Workers' provisions of the 'Labor Code, you must forthwith with such provisions or this permit shall be deemed revoked. M.inirriuinSetback Distances: 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 it work thereunder is suspended for 180 days. 1' I certify.that I have this ,yy read application and state that the above information is -correct. 1 ISSUed by: Date 6.33 Permit 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. Validated by: •r t_ Signature of app licant '" cr i Date Mailing Address Validation: City, State, Zip y ' A)240 2 4 500 R HARD COPY CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SQ. FT. ® $ 2ND FL. SO. FT. ® FOR. SQ. FT. ® GAR. SQ. FT, ® CAR P. SQ. FT. ® WALL SO. FT. ® 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./EQUIP. LAUNDRYTRAY 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 SO. FT. @ c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SQ. FT. RESID ® 11/a c SEWAGE DISPOSAL SO.FT.GAR ® 3/ac HOUSE SEWER REMARKS: VENTILATION 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./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 INSULATIONISOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL