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07119, 08921 (SFD)Addrress 54-140 Rctbi© Owner Selair Development jylailing ' ,4 f P.O. BOX 1504 78-105 CALLE ESTADO LA QUINTA, CALIFORNIA 92253 x 4 1 11LDING: TYPE CONST. OCC: GRP. P. Number 774-2€2.007 !gal Description Lot 17, Bl k 254 Address Babe Palm Dr. #6 City Zip Tel. Catwral 011 92234 324-7767 Contractor Address Tel.' State Lic. / City & Classif. 8 181 Lic. # Arch.; Engr., Designer QeSip for Living Address Tel. City IZip I State I Lic. # LICENSED CONT'RACTOR'S DECLARATION I- I hereby",affinn that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Divisiorn,3 of the Business and Professions Code, and my license is in full force and effect.,r1 i j. -'� Y �t 1 SIGNATURE DATE OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractors License Law for the following reason: (Sec. 7031.5,Bushess and ProfeSSfons Lode: Any city or county which requires a permit to construct, after, egprove, demolish, or repair any structure, prior to its issuance also requires the applicant for such permit to Me 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 civilpenalty of riot more than rive hundred dollars ($500). ❑ 1, 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 Contractors 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 no intended or offered for sale. If, however, the building or Improvement is sold within are year of cerrpletion, the owner -builder will have the burden of proving that he did not build or improve for the purpose of sale.) ❑ 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_ a_ g, 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 ❑ Copy is filed with the city. ❑ Certified copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed ff the permit is for one hundred dollars ($100) valuation or less.) I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date Owner NOTICE TO APPLICANT: ff, after making this Certificate of Exemption you should become subject to the Workers' Conpensation provisions of the Labor Code, you must forthwith comply with such provisions or Iftis permit shag be deemed revoked. CONSTRUCTION LENDING AGENCY Ihereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, 0vil Code.) Lender's Name Lender's Address This is a building permit when properly filled out, signed and validated, and is subject to expiration it work thereunder is suspended for 180 days. 1 certify that I have read this application and state that the above information is correct: I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives -of this city to enter the above-. mentioned property for inspection purposes. Signature of applicant Date Mailing Address City, State, Zip No. 07119 Project Description S•F•D+ Sq. Ft. Size 13Q$ No. Stories No. Dw. Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ — eN Am ot- ,�fvl?ey��yr Estimated Valuation �76s$6J PERMIT AMOUNT Plan Chk. Dep. 1) Zbo.rju Plan Chk. Bal.r.1 Const. Mech. Electrical b Plumbing 51.00 S.M.I. J. JZ Grading 4). UU Driveway Enc. ZU. Ou Infrastructure tri •�iJ TOTAL V 3s •� 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 INSPECTOR 2/8/93 Issued by. Date Permit Validated by: Validation: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SO. FT. ® $ UNITS COLL. AREA 2ND FL SO. FT. ROUGH PLUM . YARD SPKLR SYSTEM MOBILEHOME SVC. BAR SINK POR SO FT ® S ER ROUGH WIRING. GAR. SO. FT. ® POWER OUTLET ROOF DRAINS B FOUND. REINF. y y/JJ a GAS (ROUGH) DRAINAGE PIPING CAR P. I SO. FT. ® HEATING (FINAL) OTHER APPJEOUIP. WALL SO. FT. GAS (FINAL) DRINKING FOUNTAIN. ` SO FT ® URINAL ESTIMATED CONSTRUCTION VALUATION $ WATER HEATER WATER PIPING NOTE: Not to be used as property tax valuation FINAL INSP. FLOOR DRAIN MECHANICAL FEES WATER SYSTEM WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTOXDISH) APPLIANCE DRYER GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED FINAL INSP. LAUNDRYTRAY AIR HANDLING UNIT CFM O, 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 ® V4c HOUSE SEWER LATHING /W&i v 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 �! 7 O � BI� UNDERGROUND A.C. UNIT COLL. AREA SLAB GRADE T !� ROUGH PLUM . BONDING HEATING (ROUGH) STORAGE TANK FORMS S ER ROUGH WIRING. DUCT WORK ROCK STORAGE B FOUND. REINF. y y/JJ a GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APPJEOUIP. REINF. STEEL GAS (FINAL) TEMP. POLE 46 GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM GRADING cu. yd. $ plus x$ =$ LUMBER GR. FINAL INSP. �� / FRAMING �aP FINAL INSP. ROOFING/� � O, REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING /W&i v MESH INSULATION/SOUND p� 0 FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS t. GARDEN WALL FINAL 1 Desert Sands Unified School District CERTIFICATION OF PAYMENT OF SCHOOL FACILITY FEES TO: City of La Quinta 'f �NWO-TDATE: Depa�rt�9�en�ts o1SC u� ty Development ��T8��13(YSsCagl� �s�;�.�'���i La Quin talWA� V53 This is toertiMat. developer of located at this District, has paid scho 1 facility fees impc authorite�nera d Py G vernment C d Sectio 53080 in he amount o covering a total o square feet of ( ) residential or ( ) industrial/commercial development and that building permits for this footage in this development may now be issued by your jurisdiction. for DESERT SANDS IFIED SCHOOL DISTRICT White Build Department � ment • Yellow - Facilities Planning • Pink - Accounting • Gold - Developer 0 007 COACHELLA VALLEY WATER DISTRICT CASH RECEIPT DETAIL Received From: address: Account No. 0613Z#30 O , Lot(,) 17 Service Address 5#—//10 /LU$ O ¢• Obr ow 500 Meters) .sa ysp O -L 50 Services) Eta. zo 3 72 s C- ❑ Backflow(s) ❑ House Laterals) ❑ DetectorCheck(s) ❑ Met rSurcharge 3 �' --7 5 / S anitation Capacity Charas ` ❑ W.S.B.F.C. O ❑ Temporary Construction Meter Money ❑ Turn on Charge ❑ Uncollected Account - Name ❑ Inspection Fee - Tract - Fee - CVWD-438 (11/89) ❑ Plan Check Fees Water I Sewer - Tract - ❑ Bond Payment - A.D. - Bond Assmt. ❑ Customer Deposit ❑ Other U Si.- ^7 '7► 1 U/ r -7'A Tract .SG Bek 9-5y G.A. Code s 7r50 9 Or - '.f r .1 y TOTAL $ 4-0 `.W �` J d' 3 -SCSRemarks: .sa ysp o PAE G,0N 60ro jgzo .s$ 3, 0 Eta. zo 3 72 s C- 0 copy to: Cash 3 Water Service Check O O -` Money Cashier Order CVWD-438 (11/89) Bio R//EEC�CORDING REQUUEESjTEED BY ^^%�`4COW o U AND WHEN RECORDED MAIL TO: = O b Q r C N �V Q Ca W e Q Lu Fcu Scott Lovett �= C > Name C/O Be' Air Dc��elopment `t W / Street C/O W O .-.•. a� Address -34-116 Date Palm Dr. #6• Slao Cathedral City, Ca. 92234 $ MAIL TAX STATEMENTS TO: I Name / Addess same as above City 8 State [Gr—j TpQSPACE ABOVE THIS LINE FOR RECORDER'S USE L_ant D e e A.P.N. 1 The undersigned grantor(s) declare(s): U Documentary transfer tax is $ 19 . 25 (X ) computed on full value of property conveyed, or ( ) computed on full value less value of liens and encumbrances remaining at time of sale. X ) Unincorporated area: ( ) City of and FOR A VALUABLE CONSIDERATION, receipt of .which is hereby acknowledged, Mary Elizabeth Hield, C. Richard Hield and Robert Hield, Co -Trustees UTD 3/14/88, FBO Mary Elizabeth Hield as to an undivided 1/3 interest;* hereby CRANT(S) to Scott Lo��ett, 'a single man the following described real property in the County of Riverside State of California: ** C. Richard Hield, Mary Elizabeth Hield and Robert R. Hield, Co -Trust es UTD 3/14/88, FBO C. Richard Hield as to an undivided 1/.3 interest; and Robert R. Hield, Mary Elizabeth Hield and C. Richard Hield, Co -Trustees UTD 3/14/88, FBO Robert R. Hield,.as to an undivided 1/3 interest. Lot 5 Block 187 of Santa Carmelita at recorded in Book 19, Pages 30 & 31 of Dated: 1„n A S, 1 9 8 STATE OF CALIFORNIA 1 SS. COUNTY OF T,Os Angeles ) On June 13, 1989 before me, Laura M. Kalenderian Notary Public in and for said State, personally appeared ,Rbi)t=rt- R Field _--------------------------------- - --------------------, (known to ine) dor p.raued-tQ4Tie-errfiro-Iasis-qf-satisfactmTnid.dn= -1 to be the person whose name i �C; subscribed to the within instrument and acknowledged that }}@ executed the same. - Vale La Quinta #18 as per Map Maps ,,Records-Qf said County. M Ellizabeth 'Hie Trustee y.v-2�c)narrd •Hie%nc, Trustee Robert R. Hield, Trustee OFFICIAI, SEAL (AURA M KALEND�ERRIAN • NOTARY PUBLIC - CALIFORNIA LOS ANGELES COLK'ITY X, My COMM. expires JUN 24, 1989 WITNESS my )land and official seal. Signatu T lJ Name (Typed or Printed) (This oroa for official not seal) Title Order No. Escrow or Loan No. er.-4 MAIL TAX STATEMENTS AS DIRECTED ABOVE. '1�r= �0.j`�--:.`moo "W�','r���7F'`�. ri:��+."�'='�""�'�X`�ir51� �'�;,¢.r�s''y ^��'•]�i"y+�,`�` ,.-'�C .ti � y ,-:.. .,j(r-:,:...: RECEIPT NO.—,k� -1 / Issued B� ` Date DISTRICT: ❑ • Riverside, ❑ Indio ❑ Hemet 17 rris ❑ anc Calif. ❑ Blythe DOH -SAN -122 (Rev. 7/89) DISTRIBUTION: WHITE - Office file YELLOW - Applicant PINK - Bldg. Dept GOLDENROD - Plans/Records COUNTY OF RIVERSIDE ENVIRONMENTAL Aft"M_ "_ftftW 111im ' _ HEALTH SERVICES DIVISION PERMIT APPLICATION FOR A SUBSURFACE SEWAGE DISPOSAL SYSTEM Applicant: Submit this form with four copies of a scaled plot plan (1-20 scale) drawn to County speculations as indicated on the attached check IlsL A non-refundable filing fee (see below) is required when the application is submitted. Check must be made payable to the County of Riverside. Approval of this application shall remain valid for a period not to exceed one year from date of approval. Q VERIFY ITEMS IN SECTION A FROM BUILDING & SAFETY APPLICATION BUILDING DEPARTMENT APPLICATION LOG # Z O Contactor, Contact n &—ZU �� Phone �� resfirm � C( b U Phone Mailing Address UJ Croner U) City State Zip dobAdd rss 4egaI Description Prop. (PM, Tract,2 e � , / �Otvher (ca Lot Size Water Agency I Use of Permit P/P, CU, etc./v /�•_ 1� 1/0—a 11 fiq X �% Dwelling, MH Site Prep, etc. l i JJ f 9U Signature of Applicant Date _ CATEGORY: REV CODE FEE CATEGORY: REV CODE FEE SUBSURFACE DISPOSAL 1238 $ 57.00 ❑ SITE EVALUATION UPON REQUEST 7349 $ 43.00 m ❑ MULTIPLE PARCELS WITHIN SAME (NO PLOT PLAN) LAND DIVISION ❑ SEWER/SEPTIC VERIFICATION 7348• $ 17.00 Z O a. 1 at 4 Parcels (Each) 1238 $ 57.00 (Less than 1 year) b. Each Parcel after 4 7344 $ 24.00 ❑ PRELIMINARY ELECTIVE 7352 $ 23.00 W ❑ ' Rereview (2nd review same parcel) 7344 $ 24.00 EVALUATION (Attach DOH SAN 53) UY ❑ Site Evaluation in Conjunction with ❑ HOLDING TANK 7351 $ 47.00 Critical Area 7346 $111.00 O ALTERNATIVE/EXPERIMENTAL 7345 $222.00 ❑ Site Evaluation Lot Less than SYSTEM 10,000 Sq. Ft. 7347 $ 87.00 INITIAL DATE Holding Tank Agreements Completed ❑ Yes C No Certification of Existing S.D. System Required ❑ Yes C No WOCB Clearance required. (Attach Form ❑ Yes I No i DOH SAN 007, Santa Ana Region Only) -soda Percolation Report Required. ❑ Yes E No Special Feasibility Boring Report Required. ❑ Yes C No Detailed Contour Plot Plans Required (1 to 5 it interval) ❑ Yes I No Other ❑ Yes C No Staff Specialist Lot Inspection Required ❑ Yes ❑ No Lot Inspection Date (l Soils boring report by fT f a Project f« Date Soils Map Page Soil Type Approved by ► Date U No. of Systems Type of Systems) No. Dwelling Units (1) Septic Tank Soil Rate Grease/Sand Z 0 ❑ Holding Tank ❑ Existing XNew ❑ Replacen w -d Bedrooms. Fixture Units/ �{ Z r 2 Grease Intop hR r� � Iva /- �N ✓ U (2) Leach Linear Ft Sidewall a�lbwar� Install Lines) ft long ff wide with •Bed•W. Bottom trench area _ sq. It. min. inches rock below dreMli r�� of bottom area nning fL f� ❑ NA Leachlines/bed special design for slope: (3) Pit Diameter No. Pits Pit Below Seepage Pit Tota, Depth Other. Applicable Inlet (BI) (TD) 11 Max. Allowablepepth N/A X Overburden factor ❑ 5 1 C6 No. 2 System REMARKS: This application isPPROVE /DENIED for the category checked in SECTION B above, regarding the design of a subsurface disposal system as indicated on the accompan le Ian, using the requirements set forth in SECTION C above. A building permit is necessary for jhe installation of the Z above -designed system. No construction is permitted in the required reserved 100% expansion area. 0 ) Septic.tank and sewer lines must be fes. minimum from any wells U( Leach lines must be 100' minimum from any wells, including expansion area LU 3) Seepage pits must be 150' minimum from any wells, including expansion area U) LL �/� ) 9 ^� 'Heafth Signature of Official Date 1 L 0 RECEIPT NO.—,k� -1 / Issued B� ` Date DISTRICT: ❑ • Riverside, ❑ Indio ❑ Hemet 17 rris ❑ anc Calif. ❑ Blythe DOH -SAN -122 (Rev. 7/89) DISTRIBUTION: WHITE - Office file YELLOW - Applicant PINK - Bldg. Dept GOLDENROD - Plans/Records �.. -4 de t Of •,r,, OFFICE OF AGRICULTURAL COMMISSIONER WEIGHTS & MEASURES CALVIN C. KAMINSICAs `s JAMES O. WALLACE 4080 LEMON STREET, ROOM 19 Assistant Commissioner x Agricultural commissioner_ RIVERSIDE, CALIFORNIA 92501 CLEMENT BENVENISTE arector of -Weights & Measures (7RIVERSIDE`, 787-2561 Sealer i. 49613 Highway 86, Suite B12 !' Coachella, Ca. 92236 (619) 342-8291 !` DATE -[(—qb CASE NO. �C S 1 1� 9a.� DEVELOPER'S NAME: �o I � r D2 \1�2 I o o ADDRESS: J 140- l QoJl d a c/ F` V TELEPHONE: (b 1`.) 3 a%f -77 6 7 Y1ckv\ 13q Dear Developer: -�—,� S 2`ro J e C' After reviewing your landscaping plans, all plant material listed is not in violation of quarantine laws governing the Coachella Valley. If substitutions do occur and they differ from pliant material listed, this office must be notified immediately. Thank you for protecting and preserving the Coachella Valley's pest -free environment. . 4A A A' - d4Ae&_XA_ Agric tural Cormissioner's Office cc:: -.Indio and Riverside Office � r �; AMERICAN ENGINEERING LABORATORIES a. ....•:..--. 12200 Gm Way, Suite C _ Pdm Dmrt, CA 92260 - - p. Tdcpho (619) 311-3790 Fm (619)341-3791 Yucca Valley Apple Valley • San Diego Corona • Modesto " Palm Desert • Watertown + Hammonton • Santa Ana • Bakersfield U May 30, 1990 Account No. 81015C Belair Development 34 -116 -Date Pal>u Dr, Suite 6 Cathedral City, CA 92234 Attn: Brent Lovett Subject: In Place Density Testing Single Family Residence 54-140 Avenida Rubio La Quinta, California On May 25, 1990 a representative of this company visited the above referenced project and performed in place density tests. The results of our testing indicate that the embankment placed as -compacted fill was compacted to at least 90 percent of maximum density at the locations tested. The maximum density was determined per ASTM Test Method D1557 and the field density tests were performed in accordance with ASTM D2922. Please call, this office if you have any questions regarding the above referenced project. Sincerely, AM ICAN TGINEERING LABORATORIES, INC. Q Paul \ Hoer ing Vice P esid nt Desert Division cc: Brent Lovett (2) PRH/kc AMERICAN ENGINEERING LABORATORIES, INC...T'p..= ❑ 7940 Arjons Drive, Suite A ❑ 1490 Rincon Street, Unit Z ❑ 515 Galaxy Way ❑ 58945 Business Center Dr., Unit A San Diego, CA 92126 Corona, CA 91720 Modesto, CA 95356 Yucca Valley, CA 92284 (619)695-3730 (714)272-4230 (209)576-0813 (619)228-1754 CLIENT: lr �.J►LU�l'O VAPROJECT: S F DAT.:�/fC� .. 1( s" 1y� BUD/O /�i0t), I.D.NO: REPORT OF FIELD COMPACTION TEST TEST p LOCATION OF TEST Z -,.D TEST p LOCATION OF TEST � / O ,p © 1/ Lri�. W FIELD MOISTURE % OPTIMUM I MOISTURE % FIELD DRY DENSITY P.C.F. MAXIMUM DRY DENSITY FIELD OPTIMUM FIELD MAXIMUM PERCENT PERCENT REMARKS: MOISTURE MOISTURE % DRY DENSITY P.C.F. DRY DENSITY RELATIVE COMPACTION REL COMP. REQUIREED MOISTURE % Az -el DRY DENSITY P.C.F. Q /lam, RELATIVE COMPACTION REL COMP. REQUIRED % l ,3/, o TEST p LOCATION OF TEST Z -,.D TEST p If. -j _ /�Ae' W FIELD MOISTURE % OPTIMUM I MOISTURE % FIELD DRY DENSITY P.C.F. MAXIMUM DRY DENSITY PERCENT RELATIVE COMPACTION PERCENT REL COMP. REQUIRED REMARKS: A ss �/6 3� // W- 13,7 a � FIELD MAXIMUM PERCENT PERCENT REMARKS: MOISTURE % MOISTURE % DRY DENSITY P.C.F. TEST p 'LOCATION OF TEST ),— TEST p LOCATION OF TEST _ /�Ae' W REMARKS: ' - FIELD MOISTURE OPTIMUM MOISTURE FIELD DRY DENSITY MAXIMUM DRY DENSITY PERCENT RELATIVE PERCENT RFL COMP. REMARKS: % % FIELD OPTIMUM FIELD MAXIMUM PERCENT PERCENT REMARKS: MOISTURE % MOISTURE % DRY DENSITY P.C.F. DRY DENSITY RELATIVE COMPACTION REL COMP. REQUIRED l TEST p 'LOCATION OF TEST FIELD MOISTURE % OPTIMUM MOISTURE % FIELD DRY DENSITY P.C.F. MAXIMUM DRY DENSITY PERCENT RELATIVE COMPACTION PERCENT REL COMP. REQUIRED REMARKS: ' - FIELD MOISTURE OPTIMUM MOISTURE FIELD DRY DENSITY MAXIMUM DRY DENSITY PERCENT RELATIVE PERCENT RFL COMP. REMARKS: % % P.C.F. COMPACTION REQUIRED �2/ 43 / l3/ ISI, 7 TEST p LOCATION OF TEST FIELD MOISTURE % OPTIMUM MOISTURE % FIELD DRY DENSITY P.C.F. MAXIMUM DRY DENSITY PERCENT RELATIVE COMPACTION PERCENT REL COMP. REQUIRED REMARKS: ' - �3tLPr\R QEVFLOP \4o N RvB�o L P. vtN� V , CA - " 1 l7E\J o1EC2 \-T -Y 7C S.1 C A7\0N PSE 1 5 C AmeAcm E„gkmub,g Laboratod". Ifw— 58945 Business Center Or.. Unit A Yucca Valley. CA 92284 (619) 228-1754. P.O. BOX 1504 No. 08921 Building 78-105 CALLE ESTADO - o,.ddress 56-140 Rubio LA QUINTA, CALIFORNIA 92253 Owner P_ e R W A BUILDING: TYPE CONST. OCC: GRP. Ejlailing Address 79-•i38 Arnold Palmer vs A.P. Number ?T4-202-007 City Zip Tel. Cit cltiXitB 2253 Legal Description Lilt IT. Blk 254 Contractor Project Description SAVIOR Address City Zip Tel.' State.Lic.' - City P :& CI'assif. Lic. # Sq. Ft. No. No. Dw. '_'-Arch., Engr., Size J348 Stories -• Units Designer New ❑ Add .0 Alter ❑ Repair ❑ Demolition ❑ Address Tel. `City Zip 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. SIGNATURE DATE OWNER -BUILDER DECLARATION I hereby affirm that I 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, alter, improve, demolish, or repair any structure, prior to its issuance also - requires theapplicant 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 thathe 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.) ❑ 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 contracfor(s) licensed pursuant to the Contractor's License Law.) ❑ 1 am exempt under Sec. --B. & P.C. for this reason _t Date WORKERS' COMPENSATION DECLARATION or I hereby affirm that I have a certificate of consent to self-insur , a certificate of , Worker's 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. 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 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. Date Owner NOTICE TO APPLICANT: 11, 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. 3097, Civil Code.) Lender's Name Lender's Address This is a building permit when properly filled out, signed and validated, and is subject 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 Address City, State, Zip Estimated Valuation PERMIT. Plan Chk. Dep. Plan Chk. Bal. Const. Mech. Electrical Plumbing S.M:I. Grading Driveway Enc. Infrastructure TOTAL' R AMOUNT 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 INSPECTOR Issued by: Date Permit Validated by: Validation: h •;.r: i w. fY: 1•a• - _ , , `'f f. r 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 jDRAINAGE 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 APPIEOUIP. LAUNDRY TRAY 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. SO. FT. ®c IBATH TUB SO. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.TAI. SO. FT. RESID ® 11/4 c SEWAGE DISPOSAL SO.FT.GAR ® 3/ac HOUSE SEWER REMARKS: GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE DBL TOT>L 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 APPIEOUIP. 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 INSULATION/SOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIAIS GARDEN WALL FINAL