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10619 (RER)•4 64� �� P.O. BOX 1504 Building Address 78-003�` �a Di� V� LA QUINTACCALIFORNIA 92253 fir/14rs Joseph Kir Address same City Zip Tel. La Quinta 1 92253 Contractor wilkllain H. Fr'3t2 Address 54550 Velasco City zip - La Quint a 92253 State Lic. & Classif. B 594$54 Arch., Engr., Designer Address Tel.: 564-s4a2 City Lic. # :1123 Tel. City Zip State 11 . 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. SIGNATl1 !E S:.�t,.,�e.'sc..— "\ •��- DATE OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason: (Sec. 7031.5,Susiness 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 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). - -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.) 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 contractor(s) licensed pursuant to the Contractor's License Law.) ❑ 1 am exempt under Sec. B. & P.C. for this reason 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 t - OiCopy is filed with the city. O 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 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: It,, 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 is issued. (Sec. 3 09 7, Civil Code.) Lender's Name Lender's Address This is a building permit when properly filled out, signed and validated, and issubject 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 -of this city to enter the above-. mentioned property for inspection purposes. Signature of applicant —Date— Mailing ateMailing Address City, State, Zip No. 10619 BUILDING: TYPE CONST. OCC: GRP. A.P. Number Legal Description Project Description Construct golf cart room ZONE: BY: Minimum Setback Distances: Sq. Ft. 70 Size - No_ No. Dw. Stories. Units New ❑ Add ❑ Aiter ❑ Repair ❑ 'Demolition ❑ Side Street Setback from'Center Line Side Setback from Property Line FINAL DATE INSPECTOR Issued by: Date Permit Validated by: Estimated Valuation $3,251.00 PERMIT. AMOUNT Plan Chk. Dep. Plan Chk. Bal 29.25 Const. 45.00 Mech. Electrical 15.00 Plumbing S.M.I. .20 Grading Driveway Enc. Infrastructure, ►)}} rl .�, '*+Jf3'v; T1 A; f39 dao TOTAL 89.45 REMARKS ZONE: BY: Minimum Setback Distances: Front Setback from Center Line Rear Setback from Rear Prop. Linre Side Street Setback from'Center Line Side Setback from Property Line FINAL DATE INSPECTOR Issued by: Date Permit Validated by: Validation: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SQ. FT. ® $ 2ND FL. SQ. FT. POR. SQ. FT. ® GAR. SQ. FT. ® CARP. SQ. FT. WALL SQ. FT. ® SQ, 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. SQ. FT. ®c BATH TUB FINAL INSP. W/ —( SQ. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SQ. FT. RESID ® 1% c SEWAGE DISPOSAL SQ.FT.GAR ® 3Vic HOUSE SEWER GAS PIPING PERMIT FEE MIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEE MECH.FEE FPL.CK.FEE CONST. FEE ELECT. FEE SMI FEE PLUMB. FEE STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR SETBACK Oe 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 APPJEQUIP. 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. W/ —( FRAMING 3 241FINAL INSP. ld SRL/ ROOFING VENTILATION L� REMARKS: FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING f Mil Hf5)tj . INSULATIONISOUN FINISH GRADING FINAL INSPECTION 6 CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL q<e\v M - I vGCrC,'r w I ( 3/y sow o v¢ �co.c r vu. G .` f I� l 0v 1� c ✓�D �ovrL C pr.)C'- - L XIS<vt"3C l l� xy a (4) � I MA! L".r► i J•5� .tNy c�T.>c P c7 l � c i A.i ' [�" v Coy - Fs r � C. 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