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13932 (BLCK)4 P.O. BOX 1504 Building 78-105 CALLE ESTADO Address 52-020 Ave. Ramirez LA QUINTA, CALIFORNIA 92253 Owner Pacific Trades Mailing P.O. Box 722 1 BUILDING: TYPE CONST.— Address City Zip Tel. La Quirita, CA %2253 1 Contractor Same Address Zip State Lic. 425381 City 1955 & Classif. Lic. # Arch., Engr., Designer Address Tel. City Zip State I I Lic. # LICENSED C014TRACTOR'S DECLARATION affirmkthat*l—am licensed undbr Provisions of &�pter 9 (commencing wi Se ctior ovision 3 of life Business and ions Code, and'my license i's in full rce an� J0 'X I 1 –7 lc–/ kA SIGNATURE DATI 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, after, improve, demolish, or repair any structure, prior to its issuance also requires the applicant for such permit to role 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). 0 1, as owner of the property, or my employees with wages as their sole compensation, will do the .0 rk, 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.) 0 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 such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) 0 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 CompApdalion Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.) Pot icy No '�_ —Company C) to y is filed with the city 0 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 cr less.) I certify that in the performance of thip 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 subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shaft 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 Addres 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 cer tify 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 properly for inspection purposes. Signature of applicant Date— Mailing Address City, State, Zip A.P. Number Legal Description— Project Description No. 13932 OCC. GRP. 201 of 4'high block wall Sq. Ft. No. No. Dw. Size Stories Units New 0 Add 0 Alter El Repair 0 �Demolition 0 Estimated Valuation $366.00 PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. Const. 15..00 Mech. Electrical Plumbing .S.M.I. Grading Driveway Enc. Infrastructure TOTAL 15.0U REMARKS ZONE: BY: Minimum Setback Distances: Front Setback from Center Lin Rear Setback from Rear Prop. Line Side Street Setback from C6n'_t6rA­ine I , )/ N�_ Side Setback from Prope4y'Vine FINAL DATE INSPECTOR P Issued by: —Date . '00 Pe ik Validated by: Validation: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SO. FT. @ $ UNITS SLAB GRADE ROUGH PLUMB. BONDING YARD SPKLR SYSTEM 2ND FL. SO. FT. @ FORMS SEWER OR SEPTIC TANK ROUGH WIRING. MOBILEHOME SVC. BAR SINK POR. SO. FT. @ GAS(ROUGH) METER LOOP GAR. SO. FT. @ POWER OUTLET ROOF DRAINS GAS (FINAL) TEMP. POLE DRAINAGE PIPING CAR P. SO. FT. @ GROUT WATER HEATER WALL SO. FT. @ FINAL INSP. DRINKING FOUNTAIN, BOND BEAM WATER SYSTEM URINAL SO. FT. @ LUMBER GR. ESTIMATED CONSTRUCTION VALUATION $ FINAL INSP. WATER PIPING NOTE: Not to be used as property tax valuation FLOOR DRAIN MECHANICAL FEES REMARKS: WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN I WASH ER(AUTO)(DISH) APPLIANCE DRYER GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED LAUNDRYTRAY AIR HANDLING UNIT CFM 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 MESH SQ. FT. @ c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID @ 11/4 c SEWAGE DISPOSAL FINISH GRADING SO.FT.GAR @ 3/4c HOUSE SEWER GAS PIPING PERMIT FEE PERMIT FEE TOTAL FEES MICRO FEE MECH.FEE PL.CK.FEE CONST. FEE ELECT.FEE SMIFEE 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 ROCKSTORAGE FOUND. REINF. GAS(ROUGH) METER LOOP HEATING (FINAL) OTHER APPJEOUIP. 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 3 AX4 /u� REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATIONISOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURES11NITIALS GARDEN WALL FINAL 71