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14435 (SATT)4 P.O. BOX 1504 Building78-495 CALLE TAMPICO Address 48- 644 - pasee Tarazo LA QUINTA, CALIFORNIA 92253 owner7,1bg@x 5atrlle grg�r Z Asa©ciatea Im 12 JILDING: TYPE CONST: • OCC. GRP. �" P. Number gal Description 646-082`042 Lot fib Tract 2€ 052-4 oject Description Saa3. Laguna .ire -La Pa No. 14435 ;add;ess 6569.5 Pebble Beach City y Zip Tel. . QuintC 92253.. (519)777-7967 Contractor •u��31t'�e . Address Zip Tel.: state LIC. %'Ity & Classif. H 4$8234 Lic. # 1858: Arch:, Engr.; f�carlo$ �'liaas �' n ince- Designer g Ad5rg325 Charleavorth Dr. Te�619) 328-7272 Cit Zip State ataerral" �i, 9223 tic.# LICEN$%D�ONTRACTOR'S DECLARATION I hereby aff ir,, tjhat am licensed under Provisions of Chapter 9 (commencing with Section 7000) of Divisi 3 o the Business and Professions Code, and my license is 'n full ffoor+c`e and effect. f 7 i jl �.�✓ SIGNATURE 7 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 file a signed statement that he is licensed pursuant to . , the provisions or 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 penally of not 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 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 or property who builds or Improves thereon, and who contracts for such projects with a ciintractor(s) Qcensed pursuant to the Contractor's License Law.) . ❑ 1 am exempt under Sec. B. & P.C. for this reason Date Owner WORKERS' COMPENSATION DECLARATION 1 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 Nd" Company .�Ll 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 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 Dale Owner NOTICE TO APPLICANT. N, after making this' Certificate of Exemption you should become subject to the Workers' Compensation provisions or the labor Code,. you must forthwith comply with such provisions or this permit shall be deemed revoked. I . - - WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND - SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION.TO THE COST OF.COMPENSATION, ' DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. 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. 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 Si a 1..1562 Sto New ❑ -Add ❑ Alter ❑ No. Dw Units. Repair ❑ Demolition ❑ ZONE: BY: Minimum Setback Distances: Front Setback from Center Line Rear Setback. from. Rear Prop. Line Side Street Setback from, Ce eY Line, Side,Setback.from-.Prop ine FINAL DATE IN HECTO) Issued by:, ADate UUErlit \ 1 c? Validated by: ? Validatioh. Estimated Valuation . -$90,137.00 PERMIT AMOUNT - .Plan Chk. Dep. ' Plan Chk. Bal. 513.10 . Const. 599.00 Mech. _ 62.00 Electrical 127. 26 Plumbing 150.00 . S.M.I. t 9.10 Grading 20.00 Driveway Enc. 00 Infrastructure 2 r 028.08 TOTAL 3s508.53 REMARKS ZONE: BY: Minimum Setback Distances: Front Setback from Center Line Rear Setback. from. Rear Prop. Line Side Street Setback from, Ce eY Line, Side,Setback.from-.Prop ine FINAL DATE IN HECTO) Issued by:, ADate UUErlit \ 1 c? Validated by: ? Validatioh. 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 I DRAINAGE PIPING DRINKING FOUNTAIN URINAL WATER PIPING NOTE: Not to be used as property tax valuation ROUGH PLUMB. BONDING FLOOR DRAIN MECHANICAL FEES FORMS WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED OTHER APP.IEOUIP. LAUNDRY TRAY AIR HANDLING UNIT CFM GAS (FINAL) 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 BATH TUB FINAL INSP SO. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 11/4 c SEWAGE DISPOSAL SO.FT.GAR ® V4c HOUSE SEWER VENTILATION GAS PIPING PERMIT FEE FIRE ZONE ROOFING 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 PLUMB( G UNDERGROUND A.C. UNIT COLL. AREA SLAB GRADE ROUGH PLUMB. BONDING •HEATING (ROUGH) STORAGE TANK FORMS SEWER ROUGH WIRING DUCT WORK ROCK STORAGE FOUND. REINF. GAS (ROUGH) 3 / ETER LOOP HEATING (FINAL) OTHER APP.IEOUIP. 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. ROOFINGWRO 97 f n " Al 0 n REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING t MESH INSULATIONISOUND FINISH GRADING FINAL INSPECTION' CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL