11352 (RC)44
11352
P.O. BOX 1W4 ; ( I J!No.
Building 78-105 CALLE ESTADO ;
Address LA QUINTA,
CALIFORNIA 92253
Owner
BUILDING: TYPE CONST. OCC. GRP. -
rig
Address 3900U Ho,;x: I I r i V;_�
A.P. Number
City
Zip
Tel.
T
T -3 Qui nita
�J
9 "S 3
-1
1 '73-1361
Legal Description
Contractor -Project
Description
S,-) u `%�11 o. t C o n s t r u1: t 31 o,-1.
Address
47._25 Duneo Rk'
City
Zip
Tel:
8 3 3
State Lic.
city
& Classif.Uc.
51
#
Sq. Ft. No. No. Dw.
I
Size Stories Units
Arch., Engr.,
Designer A C
-Demolition 0
New 0 Add D Alter 0 Repair 0
Address
Tel.
7 S
568- 2",96
City
Zip
State
9, 61 0
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under Provisions of Chapter 9 ( i!19 with Section
7000) of Division 3 of. the Business and Professions C9db, and My in full force and
effect.
SIGNATURE DATE
N,
OWNEA-BUILR" DECLARATION
Estimated Valuation
I hereby affirm that I am exempt from the Contractors License Law for the following
oo
reason: (Sec. 7031.5,Business and Professions Code: Any ally or county requires a
permit to construct, after, briprove, dernofth, or repair my structure. prior to as issuance also
requires the applicant for such permit to Me a signed sleternard that he is fterised pursuant to
PERMIT AMOUNT
the provisions of the Contractor's License Law, Chapter 9 (commencirig, with Section 7000) of
11 Division 3 of the Business and Professions Code, or that. he is exempt therehom, and the basis
for the alleged exemption. Any Section 7031.5
Plan Chk. Dep.
violation of by any applicant for a Penni
r1ts the applicant to a cava penally of not more than &e hw urddollars (s5oo).
'owner
Plan Chk. Bal -
of the property, or my employees with wages as their sole compensation, will
'work, and the structure is not intended OF offered for sale. b
(Sec. 7044. Bumss and
Piares sions Code: The Contractor's
ctor's License Law does not appy to an owner of property *ft
Const. 9 0 0
builds or Improves thereon and who does such work himseff or through Aftwn oemployees,
.-
provided that such Improvements are not intended or offamd for sale- S. however, the DregMech.
or improvement is sold within one yew of completion, the owneribulder will ham the burden
Electrical
of proving that he did not build or improve for the purpose of safe.)
0 1, as owner of the property, am exclusively contracting with licensed contractors to con-
Plumbing
struct the project. (Sec. 7044, Business and Professions Code. no Contracrues License Law
does not apply to an owner of property who builds or knionoves thereon, and who contracts for
S.M.I. 10 71
such projects with a contractor(s) Acensed pursuant to the Contraclarls License Low.)
Grading
0 1 am exempt under Sec. p. & P.C. for this mason
Driveway Eric.
DateOwnerInfrastructure
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self -Insure, or a certificate of
Work r'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 7 2- C-1 6
CERTIFICATE OF OMMPnON FROM
REMARKS
WORKERS' COMPENSATION INSURANCE
(This section need not be convieted it thei pem* is for one hulled dollars (S100) vallation
or less.)
I certify that in the Performance Of thp work for which this permit is issued, I shall not
employ any
albecomerson in any manner so as to become Subject to the Workers' Comperksation
Law. of California.
0 rn
DateOwner
NOTICE TO APPLICANT. ff, after malting this Cavbfx;afe of Exemption you should beco . me
ZONE: BY:
to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shag be deemed roK*W.
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY
Side Street Setback from Center Line
Ihereby affirm that there is a construction lending agency for the performance of the
�ls
work for which this permit issued. (Sec. 3097, CM Cede.)
Side Setback from Property Line
• Lender's Name
Lender's Address
This Is a building permit when property filled ou% signed and validated. and is subject to
--'*in
FINAL DATE -INSPECTOR
I W
It work thereunder is suspended for 180 days.
fy
!f that I have read this application and state that the above information Is correct
L
Issued by: nate Permit
;J to comply with all city and county ordinances astate laws relat!rig to building
and ruction, and hereby authorize
representatives of this city to enter the abov&.
mentioned property for Inspection purposes.
Validated by:
Signature of applicant -Deft
Mailing Address
Validation:
City, State, Zip
BUILDING DIVISION
I