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14705 (RPL)iGv 78 495 5 Address O. BOLETAMPICO `� No. 147©5 Building �78„•9,�, 5 River Rock LA OUINTA, CALIFORNIA 92253 Owner Ninii titre Ili Cohistructifl.n ') , Mailing BUILDING: TYPE CONST. - OCC: GRP. Address Hountain Shadows A.P. Number ,. City Zip Tel. La Quirli•ta:l , C... 92253 Legal Description ContractorProject Description P601.. and Spa Addrresss .. e ese PC1Cf3 tear yard .: eetba ck reduced to 3•° .. approv' ed . .A. ... .. ... P.G. Box' -1791 per SR. 95-.290-,'* - City Zip T . . Zr� - Qu, inn to a . 92253 14, 2' - 521 State Lic. City & Classif.. .61.511 Lic. # . 1945 ' ' Arch., Engr_,' Designer Address Tel. City Zip State Lic. # LICENSED CONTRACTOR'S DECLARATION :. Sq. Ft. Size New ❑ I hereby affirm that I am licensed under prov,Isions of Chapter 9 (commencing with Section ,17000) of Division 3,6fthe BusinesC,li &BPrbfesslons Code,:and my license is in full force and < SIGNATURE DATE" DATE OWNER -BUILDER DECLARATION 1 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 the applicant'lor such permit to file a signed statement that. he is. licensed pursuant to. fhe provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) or ' Olvlston 3 of •the Business and Professions Code, or that. he is exempt therefrom, 'and the- basis for the - alleged exemption. Any violatlon . of Section 7031.5 -by -any applicant 'for a permit " subjects the applicant to a civil penalty of hot more than five hundred dollars•($500):., O I, as owner of the property, or my employees with wages as their sole. compensation, will. do the work, and the structure isnot Intended or offered for sale. (Sec: 7044, Buisness and Professions Code:, The Contractor's Ucense .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 Estimated Valuation - PERMIT - Plan..Chk., Dep. • a. Plan, Chk. Bal. COf1St... Mecfl... - Electrical - • or Improvement is sold within one,year of completion; the owner -builder will have the burden' of proving that he did not build ocenprove for the purpose of -sale.) _ Plumbing.. ❑'I, as owner of the property,•arn exclusively contracting with licensed contractors to con- •• struct the project. (Sec. 7044; *Business and .Professions Code: The Contractor's License ' Law • does not applyto an owner of property who builds or improves thereon, and who contracts for such projects with'a contractor(s) Qcensed pursuant to the Contractor's License Law.) . , • ❑ I am exempt under Sec. - ` B. 8 P.C. for this reason - - - - S.M.I.' •, Grading Drivewav Enc_ Date Owner WORKERS' COMPENSATION DECLARATION /reffirm that I have a certificate of consent to•self-insure, or a certificate of-Workensation Insurance, or a certified copy thereof. (Sec. 3800; Labor Code.) PolicCbmpany Y9 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.) - 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 Date Owner' NOTICE TO APPLICANT: N, after making this Certificate of'Exemption yod, should become suliject to fhb 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 abuilding 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 allf city and 'county ordinances and state laws relating* to building construction, and hereby authorize representatives -of this ,city to. enter the . abo'vez. mentioned property for inspection purposes. Signature of applicant Date Mailing Address City, State, Zip Infrastructure TOTAL No. Dw. • •• • -'Units Repair ❑ Demolition'❑ .0 0, , _ AMOUNT •f r •716.05 x:17.00 ' 4-0p V00- 45- 27.00 HLMARKS ' ZONE:' BY: MifiimumSetback Distances: Front Setback from Center Line Rear Setback from Rear Prop: Line Side Street Setback from Center Line Side. Setback from Proper�ty:Lfne FINAL DATE_ INSP�TOR'L- Issued-by: Date `�.L Permit' Validated by: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBINU FEES 1ST FL. SO. FT. ® $ 2ND FL. SO. FT. p POR. SO. FT. ® GAR. SO. FT. ® CARP. SO. 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.000L HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER GAS (ROUGH) GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED OTHER APPJEOUIP. LAUNDRY TRAY AIR HANDLING UNIT CFM 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 SO. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 11/4 c SEWAGE DISPOSAL � SO.FT.GAR ® 3/ac HOUSE SEWER REMARKS: 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 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 � REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATION/SOUND FINISH GRADING INAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL