06-0322 (PLBG)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
06-OA.0003-2-2
Property Address:
51925 AVENIDA RAMIREZ
APN:
773-165-021-9 -000000-
Application description:
PLUMBING
Property Zoning:
COVE RESIDENTIAL
Application valuation:
800
Applicant: Architect or Engineer:
0k� a(PC
LICENSED CONTRACTOR'S DECLARATION
4
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Ihereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect.
License Class: License No.:
Date: Contractor:
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the
following reason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit to
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the
permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
that he or she 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 ) (LI, 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, Business and Professions Code: The
Contractors' State License Law does not apply to an owner of property who builds or improves thereon,
and who does the work himself or herself through his or her own employees, provided that the
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 or she did not build or
improve for the purpose of sale.).
1 _ 1 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.
7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of
property who, builds or improves thereon, and who contracts for the projects with a contractor(s) licensed
pursuant to the Contractors' State License Law.).
I—) I am exempt under Sec. B.&P.C. for this reason
-54 09
Date: 'J— O er.
CONSTRUCTION LEND NG AGENCY
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the
work for which this permit is issued (Sec. 3097, Civ. C.I.
Lender's Name:
Lender's Address:
LQPERMIT
Owner:
ZAVALA OCTAVIO
51925 AVENIDA RAMIREZ
LA QUINTA, CA 92253
JAN 2 0 2006 gVja tor:
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
------------------
WORKER'S COMPENSATION DECLARATION
Date: 1/20/06
I hereby affirm under penalty of perjury one of the following declarations:
I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
issued.
I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor
Code, for the performance of the work for which this permit is issued. My workers' compensation
insurance carrier and policy number are:
Carrier Policy Number
_A:_1 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,
and agree that, if I should become sub'ect to the workers' compensation provisions of Section
3700 of the Lab Code, I F I fo vith comply wi ose provisions
J'"
plicant:
WARNING: F ILURE TO SECURE WORKERS' COMPENSATI OVERAGE IS UNLAWFUL, AND, SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUN DREOTHOUSAND
DOLLARS 1$100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVjDEO FOR IN
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the
conditions and restrictions set forth on this application. '
1 . Each person upon whose behalf this application is made, each person at whose request and for
whose benefit work is performed under or pursuant to any permit issued as a result of this application,
the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City
of La Quinta, its officers, agents and employees for any act or omission related to the work being
performed under or following issuance of this permit.
2. Any permit issued as a result of this application becomes null and void if work is not commenced
within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject
permit to cancellation.
I certify that I have read this applicati and state that the above information is correct. 1 agree to comply with all
city and county ordinances and a laws relating to building con cY ,and here�representas
of thi ounty to enter upon above-mentioned property s ses.
ate: x-10 6 gnature (Applicant or Agent):
Application Number
Permit
Additional desc .
Permit Fee . . . .
Issue Date . . . .
Expiration Date . .
. . . . 06-00000322
PLUMBING SEWER
30.00 Plan Check Fee
Valuation
7/19/06
.00
800
Qty Unit Charge Per Extension
BASE FEE 30.00
----------------------------------------------------------------------------
Special Notes and Comments
SEPTIC ABANDON; SEWER CONNECT
Fee summary Charged Paid Credited Due
---------------------------------------------------------
Permit Fee Total 30.00 .00 .00 30.00
Plan Check Total .00 .00 .00 .00
Grand Total 30.00 .00 .00 30.00
LQPERMIT
Bin #
City .of La Quanta
Building U Safety Division
Permit 1f
P:O. Box: 1504, 78-495 Cale Tampico
3�'
La Quinfa, CA.92253 - (760) 777-7012
MEMO=Building
Permit Application. and9 Tracking. Sheet
Project Address:
a
/
.Owner's Name: Lr .,Jo V Z W
A. P. Number:
f
Address:, C5 j'. Z l/� � 0Z
Legal Description:
City, ST, Zip:, CA
Contractor:
•
Telephonef .6'0 SG — 3:?_2
Address:
-
City, ST, Zip:
Project Description: �C S
Telephone:
State. Lie. # :
City.Lib. #:
Arch., Engr., Designer: "
Address:
City, ST, Zip:
'
Telephone:
State-Lic. #:
Construction Type: Occupancy;
_.
'
Name of Contact Person:
Project •type (circle:one): New Add'n Alter Repair Demo
Sq. Ft :
#Stories:
# Units:
Telephone # of Contact Person:
.
Estimated Value of Project:
,APPUCANT• DO' NO.T-WRITE"BEiOW
-THIS UNE
'
#
SubmittalReg'd
'
Rec'd,
TRACIMG
Plan Sets
PERMTr FEES
Plan Check submitted .
Item
Structural Calcs.
Revievred, ready for corrections
Amount
Truss Calcs.
Plaa Check Deposit:.
Called Contact Person
"
Plan Check Balance
Energy Calcs.
Plans. Picked. up
'
Flood plain plan
Plans resubmitted
Construction
Grading. plan
V Review, ready for correctioaWeissue
Mechanical
Electrical
Subcontactor List
Called Contact Person
Grant Deed
Plans picked up
Plumbing
H.O.A. Approval
Plans resubmitted
S.M.I:
IN HOUSE:-
Review; ready for. correctionstissue
Grading
Developer Impact Fee.
Planning Approval
'
Called Contact Person
Pub. Wks. Appr
Date of permit issue
A.I.P.P. .
School Fees
Total Permit Fees
OWNER/BUILDER INFORMATION
Dear Property Owner:
An application for a building permit has been submitted.in your name listing yourself as the builder of the property
improvements specified.
For your protection you should be aware that as "Ovvner%Builder" you are the responsible party of record .on such a
permit. Building permits are not required to be signed. byproperty.owners.unless they are personally performing their
own work. If your work is: being performed by someone other, tfian yourself, you may protect yourself from possible
liability if that person applies -for the proper, perni t in, -his or her name.
Contractors are required.by law to be licensed and bonded by the State of California and to have a business license
from the City or County�They are also_ required by. law to put their'license.number on all permits for which they
apply.
If you plan to do your own work, with the exception of ,various trades that you plan to subcontract, you should be
aware of the following,information for your benefit and protection:
If you employ or otherwise engage any persons "other than your immediate family, and the work (including materials
and other costs) is $200..00 or ,more for- the entire project, and such persons are not licensed as contractors or
subcontractors;'then you: maybe an employer.
-If-you are an employer, you must register with the State and Federal Government as an employer and you are subject
to several obligations include State and Federal- income tax withholding, federal. social security taxes, worker's
compensation insurance, disability insurance costs and unemployment compensation contributions.
There may be financial risks for you if you do not carry out these obligations, and these risks are especially serious with
respect to worker's compensation insurance.
For more specific information about your obligations under Federal Law,.'contact the4nternal Revenue Service (and, if
you wish, the U.S. Small Business. Administration. For more specific informationabout your obligations under State
Law, contact the Department of. Benefit Payments and"the Division of Industrial Accidents.
If the structure is intended for sale,. property. owners who are not licensed contracts are allowed to perform their
work personally or through their own employees; without a licensed contractor or subcontractor, only under limited
conditions.
A frequent practice of unlicensed persons professing to,be contractors is to secure an "Owner/Builder" building
permit, -erroneously implying that the property owner is providing his or her own labor and material personally.
Building permits are'not required to be signed -'by property owners.'unless they are performing their own work
personally.
Information about licensed contractors may; be obtained by contacting the Contractors' State License Board in your
community. or at 1020 N. Street, Sacramento, California 95814.
Please complete and return the enclosed owner -builder verificationform so that we can confirm that you are aware of
these matters. The building permit will not ie issued until the verification is returned.
Very truly yours,
CITY OF LA QUINTA.
DEPT. OF BUILDING AND SAFETY
78-495 Calle Tampico
La Quinta; CA 92253
(760) 777-701
FAX: (760
OWNER'S SIGNATU }
2 -
PROPERTY ADDRESS
PERMIT NUMBERS)
VALLEY WIDE PUMPING SERVICE y� . ._J0B. jNV010E
"Your Waste Is Our Problem" 10 2 0
1UU 3. Z)unrlse way oulLe 13.3
PALM SPRINGS, CA 92262
DESCRIPTION OF MATERIAL USED
CUSTOMER'S ORDER NO.
DATE ORDERED
ORD TAKEN BY
• �{/•
ATE PROMISED
0 A.M.
0 P.M.
(7V0) 322-2400 (760 347-3545
60
BILL O
Pumping Fee per 1000 gal.
ADD. ESS-
- -
MECHAry1/C,
/ ;%
CITY
Dumping Fee per 1000 gal.
..JOB NAME ANIT LOCATION
❑DAY WORK
❑CONTRACT•
0 EXTRA
DESCRIPTION OF WORK /�
C/
7
QUANT.
DESCRIPTION OF MATERIAL USED
PRICE
AMOUNT
Gallons Lz'A,? r /000
:,i1-
Pumping Fee per 1000 gal.
Dumping Fee per 1000 gal.
Out of Area Fee
Locating / Opening Fee (per hour)
Size System: n
A SERVICE CHARGE OF $20 WILL BE DUE
ON ALL RETURNED CHECKS.
A FINANCE CHARGE OF 11/2% PER MONTH, 18% PER YEAR
WILL BE CHARGED ON PAST DUE ACCOUNTS OVER 30 DAYS.
HOURS
LABOR AMOUNT
TOTAL
MATERIALS
MECHANICS @
HELPERS @
TOTAL
LABOR
I hereby acknowledge the satisfactory TOTAL LABOR
completion of the above described work:
TAX
SIGNATURE
DATE COMPLETED
TOTAL�--
To ReCIII&LEBS CUSTGIVIl "printing service TOLL FREE 1-806888.6327 NESS, Inc., Peterborough, NH 03458. _ Ref. ND: G 71070/3566 . ;
M -
NOTICE TO OWNER
Under the California Mechanics Lien Law any contractor, subcontractor, laborer, supplier
or other person who helps to improve your property, but Is not paid for his/her work or
supplies, has a right to enforce a claim against your property. This means that after s court
hearing, your property could be sold by a court officer and the proceeds of the sale used to
satisfy the indebtedness. This can happen even if you have paid your contractor in full if the
subcontractors, laborers or suppliers remain unpaid.
To preserve their right to file a claim or lien against your property, certain claimants such
as subcontractors or material suppliers are required tb provide you with a document entitled
"Preliminary Notice:' Original (or prime) contractors and laborers for wages do not have to
provide this notice. A Preliminary Notice Is not a lien against your property. its purpose is to
notify you of persons who may have a right to file a lien against your property If they are not
paid. Generally, the maximum time allowed for filing a claim or lien against your property is
ninety (90) Days after completion of your project. '
TO INSURE EXTRA PROTECTIONTOR YOURSELF AND YOUR PROPERTY,
YOU MAY WISH TO TAKE ONE OR MORE OF THE FOLLOWING STEPS:
1) Require that payments be made directly to subcontractors and material suppliers through
a joint control. Any joint control agreement should include the addendum approved by the
Registrar of Contractors,
2) Issue joint checks for payment, made out to both your contractor and subcontractors or
material suppliers Involved in the project. This will help to Insure that all persons due payment
are actually paid.
3) After UPON making payment on any completed phase of the project, and before making
any further payments, require your contractor to provide you with unconditional lien releases
signed by each material supplier, subcontractor and laborer involved in that portion of the
work for which payment was made. On projects involving improvements to a single family
residence or a duplex owned by individuals, the persons signing these releases lose the right
to file a claim against your property. In other types of construction this protection may still be
Important, but may not be as complete. TO PROTECT YOURSELF UNDER THIS OPTION YOU
MUST BE CERTAIN THAT ALL MATERIAL SUPPLIERS, SUBCONTRACTORS OR LABORERS
HAVE SIGNED.
P.O. Box 1504 -APPLICATION ONLY
Building � � i 7&105 CALLS CALIFORNIA9
•Address LA QUINTA, ORNIA 92253
Owner _
mailing
Address
'��
Cjty.10
. � •Q l� V l/�/r7�
Contractor.
i •
,._.Address-
City _ % Zip Tel..
L
—State Ljc. V _ City /
& Classif. V Lic. #
Arch., Engr.; * -
_Designer
Zip Te.
Sb
.Al .AA i-
J
BUILDING7--TYPE-CONSTT••-- -------OCC. GRP. -A.P. Number.
Legal Description L O_S ,
Project -Description S�
Sq. Ft.
Size - -y
New 0.
No.
Stories
AOO:u - r- - Alter. u. -
No. Dw.
Units
Repair -O �:_. 'Demolition -0. •� -
Address
Tel.
(_T- _ ....
City
Zip
State ''F.
Lic. # -
_ LICENSED CONTRACTOR'S DECLARATION
.
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section `
7000)o Division 3 of the Business and Professions Code, and my license is in full force and
t
effect. -
SIGNATl1RE DATE
1
OWNER -BUILDER DECLARATION-
Estimated Valuation -
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, atter, improve, demolish, or repair any structure, prior to its Issuance also
requires.. theapplicant for such permit to rile a signed statementthat -he is licensed pursuant -to
- -PERMIT •-- -- - • -AMOUNT-
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 or Section 7031.5 by 'any applicant for a permit
Plan Chk. Dep. ;-�•�- - -
subjects the applicant to a civil penalty of not more than five hundred dollars.($500).
Plan Chk. Bal.
❑ I, as owner of the property, or my employees with wages as their sole compensation, will
_ I
`do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and
Const.
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,
Mech. - - - - - - -
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
;sip
-, of proving that he did not build or improve for the purpose of sale.) _ - _ _ _ . _
_Electrical
* _
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con.
Plumbing
• 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.I. -
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
�
Grading
❑ I am exempt under Sec.- B. & P.C. for this reason
-
Driveway,Erjc.
Date
-
ffaStrU1 ht.Ur
owner
i
r✓
.WORKERS' COMPENSATION DECLARATION
MMAL Kiln .125
r
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.-
- - - - -
TOTAL
_ 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 thq 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. -If, .after making this Certificate of Exemption you should become
ZONE: BY: -
subject tb the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked. '
Minimum Setback Distances: 'r i
Front Setback from;Center-Line
' _ J
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 if work thereunder is suspended for 180 days.
- - - — - -�
- I certify that I have read this application and state that the above information is correct.
Issued by: Date Permit
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.
Validated by:
Signature of applicant _ T1 Date
Mailing Address - -
Validation:
City, State, Zip
l
BUILDING DIVISION
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
COLL. AREA
2ND FL. SO. FT.
YARD SPKLR SYSTEM
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SO. FT.
DUCT WORK
DRAINAGE PIPING
WALL SO. FT.
DRINKING FOUNTAIN
SO FT ®
HEATING (FINAL)
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
GRADING
cu. yd.
$ -plus-x$_=$-
lusx$=$ROOFING
LAUNDRYTRAY
AIR HANDLING UNIT CFM
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
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1 c
SEWAGE DISPOSAL
FIREPLACE
SO.FT.GAR ® 3/.c
HOUSE SEWER
SPARK ARRESTOR
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./EOUIP.
REINF. STEEL•
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ -plus-x$_=$-
lusx$=$ROOFING
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
CALVIN C..KAMINSKAS.
Asslslont Coriimmissloner
(714) 275.3000 •`-.
r
i
• *iii ��•
• OFFICE OF
AGRICULTURAL, -COMMISSIONER -
JAMES O: WALLACE, Commlesloner
83-612 Avenue 45 .Suite,7
Indio CA 92201-:
(619) 342-8291
i
•/ d r j�,
K P.O. BOX 1504' APPLICATION ONLY
Building Q f 78-105 CALLE ESTADO
Address]-/ `o r%• ' = ' .LA QUINTA, CALIFORNIA 92253
Owner
/5 M77 LJ Hyc_ alBUILDING: ;TYP.E CONST. OCC. GRP.
Mailing , ` /
Address �Z A.P. Number
City Zip Tel. /
L1---Zo7. 3 Legal. Description 4 t S�
Contractor
Project_Description •t
Address
City Zip Tel..
State Lic. City
& Classif. (� �^11 Lic. # " c
�� Z v 6 . ;. / .. s� Sq 'Ft*
No. No. Dw.
Size S Stories Units
Arch., Engr.,
Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address Tel.
City zip State
r, 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 p .
effect.
SIGNATURE DATE '
OWNER -BUILDER DECLARATION a Estimated Valuation
I hereby affirm that I am exempt frorri''.the Contractor's license Law for the: following' .
reason: (Sec: 703f:5,Bus1ness and Professions Code: Any city or county which, requires a
permit to construct,,. atter. Improve,' demolish, or repair any.structure,'prior to`llsilssuance�also ,.
requires the'.appucant•for such 'permit to file a signed statement that he, is.lkensed•pursuant to PERMIT AMOUNT
the provisions of the Contractor's License Law, Chapter•9 (commencing."wfh Section 7000), of • -
Division 3 of the. Business and' Profession Code. or that. he is exempt therefrom, -,and. the, basis '
for the alleged exemption.,Any violation of Section -7031.5`byy'any applicant for a'permft Plan. Chk.•Dep:
subjects the applicant to a civil penalty of nod more than five hundreddollars ($500). '
❑ I, as owner of the property, or my'employees with wages as their,sole'compensation, will. P.Ian Chk. Bal:
do the work, and the structure is not Intended or offered for sale. (Sec. 7044, Buisness and+ Const..
' 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, • Mech.
provided that such_, improvements are not intended. or'oHered-for sale. If, however;llhe building
or improvement Is sold within one year of; completion, the. owner -builder will have the burden Electrical
of proving that he did not bufld or Improve for the purpose o! sale.) _ y(w' '
b I, as owner of the'property, am exclusively' contracting with licensed contractors to con- Plumbing
struct the project. (Sec. 7044, Business and Professions; Code: The 'Contractor's License' Law` .. -
does not apply to an ownei of property. who, builds or Improves thereon, and. -who contracts for- ' S-.M.I.
such projects with a contractor(s) licensetlpursuant to.the Contractor's License Law.) ,
Grading
O 1 am exempt under Sec. 5B. 8 P.C. for this reason
`
YDriveieiay Enc.
Date owner nfrastr6ctuirrp.
WORKERS` COMPENSATION:OECLARATION 's `
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.
TOTAL'
CERTIFICATE OF EXEMPTION FROM- + REMARKS
WORKERS' COMPENSATION INSURANCE
his section need not be completed. if the �'
R p permit is !or' one hundretl dollars (S 100) valuation i
or less.) -
I certify that in the performance of thQ work for which this permit is issued, l shall not
employ any parson in any manner so as to become subject to the Worker's', Compensation
' .Laws of California.
• r
Date Owner
NOTICE TO APPLICANT: If, after making this Certificate of- Exemption you should' become ZONE: BY:"
subject to the Workers' Compensation provisions of; the Labor Code, you must forthwith Minimum Setback Distances:
comply with such provisions or this permit shall be deemed revoked. e ,
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 permitwhen'properly filled out,. and -validated, and is subject to
;expiration It -work thereunder lstsuspended for 180 days. +
I certify that I have read this application and state that the above information is correct. Issued by: Date Permit
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. .r Validated•by:
Signature of applicant Date
Mailing Address Validation:
City, State, Zip .
,' - FINANCE t
4 :t
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DESERT SANDS 'UNIFIED SCHOOL DISTRICT
`82 879 Hglway`111.'
NOTICE: ` Indio, CA 92201
Document Cannot 13e -Duplicated (619).347-8631:
..4 ..
Date ,1_ /13/9`L~ g Type of Permit ILa Quinta
No.
11113 Permit
x Log #
-Owner Name Expectation,:Con' tfudtion
°No. 51380 Street - Ramire'z
city6it
una Zi 92253 . stud 112
Q p -Study Area
APN.N Tract,li, Lot Square.Footage 322$
Type„of Development' Single''Fan ly ReSlderice No., of units
Comments ;51380 Rairiirez 1614 51295 RamirP7. 1 Fi1`4 .SnuarP' FPPt
t
At the present time, the Desert -Sands Unified School District °does not collect fees on
garages/carports, covered] patios/walkways, residential additions under 500 square feet,
detached,accessory.str uctures`o` r replacement niobilehomes '4t has been determined
the above=named'�owner-is exempt from paying school fees at this time" -due to the'
following reason:
EXEMPTION NOT•'APPLICABLE
This certifies that;s
in the amount of
the -property listed,-
this square,footage
hooTfacsl ty feesiimposed`puYsuant to:; Government Code 53080 .
i X ar$ 5,100:24 have been paid to DAU 9M for
bove and .that building permits' and/or Ceitihcates: of Occupancy for
Fees Paid By Expectation, Construction
Name on the check ”
' Te;ephone '.564 -OM
By James E. Lively-,
Assistant Superintendent, Business Services W
Y ..
Fee.collected Lexempted'by ,..Vkkie J Durrett
Payment Received
Signature
�(�' J�tt� �� t.L,� Check No. 579
,C.�C c..�.c
Collector: Attach a copy of county or city plan check aPP., cationform to district copy for all waivers.
Embossed. Original- Building DeptJApplicant Copy - Applicant/R.eceipi Copy - Accounting
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