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15228 (AR)1 Qum& „r P.O. BOX 1504 Building 78-495 CALLE TAMPICO Address49-090 luso ' rem o LA OUINTA, CALIFORNIA 92253 Owner • Delancy BUILDING: TYPE CONST. Mailing . Address49-090 PIs© Tiem.po City Zip Tel. La Quinta 92253 Contractor Sharks Constarixction .__.__-P.O. Box 1716 La Quinta . 92293 State Lic. City & Classif. 574074 Lic. # 2996 :.Arch., Engry .,Designer '•ohn 3.- Vuksic, V a V Arch. + Address .Tel. 28145 Crocus 345-2290 City Zip State Palm -Desert 922:1 Lic. # C192I.0 LICENSED CONTRACTOR'S DECLARATION AI herebyy affirrrytfiat`I•amns d u licender provisions of Chapter 9 (commencing with Section 7000)-Mivisip 3 of theAGsiness and Professions Code, and my -license is in full for a and ef;fec f > f _ 1 �s r SIGNATURE lE+`aC. ti/�� 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 rile 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). D 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, auisness 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.) O 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) Dcensed pursuant to the Contractor's License Law.) ❑ 1 am exempt under Sec. B. & P.C. for this reason Date Owner WORKERS' COMPENSATION DECLARATION I herebyraffirm 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 111,dopy is filed with the city, . ❑ Certified copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATIONINSURANCE (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 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., N, 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. 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 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. This is a building permit when property 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 ateMailing Address City, State, Zip No. 15228 OCC. GRP, Legal Description Project Description Fanily Room 'Addition Sq. Ft. Size 1 New ❑ No. Stories No. Dw. Units AdCHIN Alter ❑ Repair ❑ Demolition ❑ REMARKS ZONE: BY: Minimum Setback Distances: Front Setback from Center Line Rear Setback from Rear Prop. Line Side Street Setback from 1136i4ter Line Side Setback fr pefy Lmp-- FINAL DAT INSPE( Issued by: Date Validated by: Validation: stimated Valuation. $8,725.00 PERMIT AMOUNT Plan Chk. Dep. Plan Chk: Bal. S 70.-20 Const.. S102.00. . Mech. Q Electrical 2 Plumbing S.M.I. `` R7 Grading Driveway Enc. Infrastructure TOTAL $215.12 REMARKS ZONE: BY: Minimum Setback Distances: Front Setback from Center Line Rear Setback from Rear Prop. Line Side Street Setback from 1136i4ter Line Side Setback fr pefy Lmp-- FINAL DAT INSPE( Issued by: Date Validated by: Validation: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SQ. FT. ® $ 2ND FL. SO. FT. ® POR. SQ. FT. ® GAR. SQ. FT. ® CAR P. SQ. FT. WALL SO. FT. ® SO. FT. ® ESTIMATED CONSTRUCTION VALUATION $ UNITS MOBILEHOME SVC. POWER OUTLET YARD SPKLR SYSTEM BAR SINK ROOF DRAINS DRAINAGE 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 WASH ER(AUTO)(DISH) APPLIANCE DRYER GAS (ROUGH) GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED OTHER APP./EQUIP. LAUNDRYTRAY AIR HANDLING UNIT CFM TEMP. POLE 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 SQ. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 1 Va c SEWAGE DISPOSAL SQ.FT.GAR ® 3/ac HOUSE SEWER REMARKS: VENTILATION 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 ROCKSTORAGE FOUND. REINF. GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APP./EQUIP. 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 r REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATION/SOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURES/INITIALS GARDEN WALL FINAL -�-` DESERT SANDS UNIFIED SCHOOL DISTRICT 82-879 Highway 111 NOTICE: Indio, CA 92201 Document Cannot Be Duplicated 619-775-3500 Date 11/9/95 Type of Permit La Quinta No. 13862 Permit # Log Owner Name T. D. Desert Development. (Delancy) g6_0g0No. 49696' Street Paso Tiempo City La Quinta Zip 92253 study Area • 123 APN # Tract # E Lot # 0 Square Footage 1112 Type of Development Residential Addition No. of units Comments Family Room Addition 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 structures or replacement mobilehomes. It has been determined the above-named owner is exempt from paying school fees at this time due to the following reason: Residential Addition 500 Sq Feet or Less EXEMPTION NOT APPLICABLE This certifies that school facility fees imposed pursuant to Government Code 53080 in the amount of 0.00 x 112 or $ 0.00 have been paid to D.S.U.S.D. for the property listed above and that building permits and/or Certificates o f Occupancy for this square footage in this proposed project may now be issued. Fees Paid By N/A Telephone Name on the check By Dolores A. Ballesteros Superintendent Fee collected /exempted by Pauline Pearson Signature, e1e , a Q M a \F�o ALA A /ce w $0.00 Check- No. N/A_ Collector: Attach a copy of county or city plan check applicationform to district copy for all waivers. Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt . Copy - A --counting ,r s; r- $0.00 Check- No. N/A_ Collector: Attach a copy of county or city plan check applicationform to district copy for all waivers. Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt . Copy - A --counting