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04601 (RPL)4 04-001 P.O. BOX 1504 Building 78-105 CALLE ESTADO Address 34-520 Ramirez .,LA-QUINTA,;9CALIFORNIA,92253 Mailing Address Std City • Zip Tel. La 011izinta 92253 Contractor ress ity jZip I Tel. State Lic..City ` & Classif. 3.58739 Lic. q Arcn., tngr., Designer Address Tel. CityI Zip I State I Lic. ff LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of'Chapter 9,(commencing with Section 7000) t. of Division 3 of the Business and Professions Cccl§;3and-niy.license is in full force and effec'j• `' l." `' SIGNATURE '.:..r°' 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, after, Improve, demolish, or repair any structure, prior to Its Issuance also requires the applicant for such permit to the 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 rive hundred dollars ($500)- 0 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- structthe 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.) O 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 O Copy 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 the work for which this permit is issued, I shall *not employ any person in any manner so as to became subject to the Workers' Compensation Laws of California. Date Owner NOTICE TO APPLICANT: If, alter 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 NSPECTOR This is a building permit when properly filled out, signed and validated, and is subject to FINAL DATE I - d+ / expiration if work thereunder is suspended for. 180 days. .1 certify that I have read this application and state that the above information is correct. ISSUed' by: Date Permit BUILDING: TYPE CONST. OCC. GRP. A.P. Number 774'202.425 Legal Description Project Description ® and 144" OIC retaining wall. Sq. Ft. No. No. Dw. Size Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ r itimated Valuation $110500 PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. .12 Const. • 9 2.50 Mech. 116600 Electrical 20.00 Plumbing 14100 S.M.I. Grading Driveway Enc. Inf rastructure TOTAL REMARKS NIIx 2ASS, 14 Vwf K;_i_t3 -#fvltotdw', 6 12 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 agree to comp y 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 Date Mailing Address Validation: C't St t Z y, a e, I p WHITE FINANCE PINK APPLICANT GREEN . 9tJIL01N0, G01,0ENfIQO 6,559660R S OFFICE HARD COPY FILE y. enc t9 Y ,.M ..f i... S_1k. .d;•1 .1�•. •l.c_. w. CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES IST FL SO FT rp $ UNITS SLAB GRADE ROUGH PLUMB/6. /l/:9 BONDING YARD SPKLR SYSTEM 2ND FL SO FT. @ FORMS SEWER OR SEPTIC TANK ROUGH WIRING MOBILEHOME SVC. BAR SINK ppq SO FT. GAS (ROUGH) METER LOOP HEATING (FINAL) POWER OUTLET ROOF DRAINS GAR SO. FT. TEMP. POLE GROUT DRAINAGE PIPING CAR P. SO FT. � FINAL INSP. I/ BOND BEAM G- /�/- y WATER SYSTEM DRINKING FOUNTAIN WALL SO. FT. Q =$ LUMBER GR. FINAL INSP. URINAL SO. FT. a ROOFING ESTIMATED CONSTRUCTION VALUATION S ./-, S �YL/ ��(�� v WATER PIPING NOTE: Not to be used as property tax valuation FLOOR DRAIN MECHANICAL FEES VENTILATION WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASH ER(AUTOKDISHI APPLIANCE DRYER FIREPLACE 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, 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 114 c SEWAGE DISPOSAL SO.FT.GAR rp 3:c HOUSE SEWER ' CERT. OCC. 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 8 AIR COND. SOLAR SETBACK GROUND PLUMBING UNDERGROUND A.C. UNIT COLL. AREA SLAB GRADE ROUGH PLUMB/6. /l/:9 BONDING HEATING (ROUGH) STORAGE TANK FORMS SEWER OR SEPTIC TANK ROUGH WIRING DUCT WORK ROCK STORAGE LIND. REINF. /, ^ // Cl ! / GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APP.IEOUIP. REINF. STEEL GAS (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. I/ BOND BEAM G- /�/- y WATER SYSTEM GRADING Cu. yd. $ plus xE =$ LUMBER GR. FINAL INSP. FRAMING FINAL INSP. ROOFING tote aaL ./-, S �YL/ ��(�� v $'�/ REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR.. FIREWALL LATHING MESH.. INSULATION/SOUND FINISH GRADING FINAL INSPECTION ' CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESlINITIALS , GARDEN WALL FINAL