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10330 (BLCK)Building P Address 509+65 Mtn Shcidow ' Owner Dor. Wad/dheroke€: games Mailing Address T., I Zip ITel. uu�cW P.O. BOX 1504 NO. = 1 U 3 O 0 78-105 CALLE ESTADO LA QUINTA, CALIFORNIA 92253 BUILDING: TYPE CONST: OCC: GRP.. 4 A.P. Number t ' Legal Description w Contractor Y Aviva v nstruation Project Description Address -78 1 i:Qf fi 1 block wca1.1 ' 74955 Goleta CityZip Tel.: ' P.D.. 9225U 340'-0302 I State Lic. City rz , & Classif. $ 622301 Lic. # 1994 Sq. Ft. No.' .. No. Dw. Size- Stories: Units Arch., Engr.,:. - r . Designer New ❑ Add ❑ _ Alter ❑ Repair ❑ Demolition ❑ Address Tel. City Zip State Lic. # LICENSED CONTRACTORS DECLARATION I hereby affirm`th t I am licensed under.p ovisions of Chapter 9 (commencing with Section 7000)rof Divisioni3 of the Business and. Professions Code, and my license is in full force and 1 t^efct , �. IGNATURE=! - DATE OWNER-BUILDER 9 fromthe Contractor'slNicense lafor the following I hereby affirm that I am r p1 reason: (Sec. 7031. S,Buslness and Professions Code: Any city or countywhich requires a %.. permit to construct, atter, improve, demolish, or repair any structure, prior to its issuance also ., w_ .,,; requires the applicant /or such permitto 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 0/ the Business and Professions Code, or that. he is exempt fherelrom, and the basis r •</or thealleged exemption.. Any violation o/ Section 7031.5 - by 'any applicant for a permit - subjects the'applicant'to a civil penalty of not more than five'hundred dol/ars.(8500). ,1,`,'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 toanowner o/ property who;. builds or improves thereon and who does such work himself or through his own employees, .., f provided that such improvements are not intended or offered /or sale.- If; however, the, building Estimated Valuation _ 950 • .PERMIT ;.:• ' ., AMOUNT t Plan Chk. Dep: _ c Plan Chk. Bala. .COrtst..: ' 3 ex • U U �• rtx Mech. EI@CtrlCdl - or improvement is, sold within one year o/ completion, the owner -builder will have the burden '. o/ proving that he did not build or improve for the purpose of sale.), Plumbing - ❑ 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 S. M.1. _ •. - - • �` • .LVA such projects with a contractor(s) licensed pursuant to the Contractor's License Law.). ❑ 1 am exempt under Sec. - B: 8 P.C. for this reason Grading _ - , A. M' 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 ' Worker's"Compensation•Insurance; or acertified copy thereof. (Sec., 3800; Labor Code:)' - Policy No. - 'Company €7 Copy is filed with the city. ❑ Certified copy is hereby furnished. + " ` AACZ? C.f1 CA AQ -K i4-'%3-911 �• 7t '} . TOTAL : � f1 1 - `t ,t 8? i 3L 1 �3 a s:fiI.. ' CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE 4 (This section need not be' completed i/ the permit is for one hundred dollars (S 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 REMARKS - _ I• - - - - Date Owner NOTICE TO APPLICANT: 1/, alter 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. - i=ZONE: - `By:, - r' •+ Minimum Setback Distances: " Front Setback fromCenterLine __'_Rear Setback from Rear Prop. Line - coNSTRucnoN 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.)', i $Iris Setback from Property Line Lender's Name .. - Lender's Address' ' . This is a'buildin g permit when properly filled out, signed and validated, and is subject to.:...' expiration if work thereunder is suspended for 180 days. FINAL DATE INSPECTOR I certify that I have read lhis'application and state thatthe'above information is correct. i I 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 theabove. - mentioned property for inspection purposes. ,Issued by; - Validated by: -Date.Permit Signature of applicant t Date , Mailing Address Validation:. City, State, Zip, CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SO. FT. ® $ 2ND FL SO. FT. POR. SO. FT. ® GAR. SO, FT. ® CAR P. SO. 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.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER GAS (ROUGH) GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED OTHER APPJEQUIP. LAUNDRYTRAY AIR HANDLING UNIT CFM TEMP. POLE 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. SO. FT. ® c BATH TUB SO. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 1% c SEWAGE DISPOSAL SO.FT.GAR ® 3Yec HOUSE SEWER REMARKS: GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEE MECH.FEE PLCK.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 ` F UND. REINF. / —v^2 % ` GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APPJEQUIP. REINF. STEEL GAS (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. NO BEAM �l �W 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 SIGNATURESIINITIALS GARDEN WALL FINAL