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13706 (RER)City Zip State f Lic. # V LICENSED CONTRACTOR'S DECLARATIONa• I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section' 0000) of Division 3 of the Busmess'and Professions Code, and my license is in full force and '- effect.,,. W P.O.-BOX 1504, No. IL3 05 Building�,,,�� Address ROCSL l 78-105 CALLE ESTADO LA QUINTA, CALIFORNIA 92253 reason: (Sec. 7031.5,Business and Professions Code: Any city ofcountywhich requires a, . permit to construct, alter, Improve, demolish, or repair any structure, I prior to its issuance also • requires the applicant for such permit to file a signed statement that he Is licensed pursuant to .PERMIT - - - AMOUNT Owner J. Peter Minist.:�e11 _ w 'subjects the applicant to a civil penalty of not more than five hundred dollars ($500). Plan Chk. BBI. - - 93.60 ❑ 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 Const. 4 �'� ` Professions Code: The Contractor's License Law does not apply to an owner of property who Mailingt builds or improves thereon and who does such work himself or,through his own employees, Mech. - provided that' such improvements are not intended or offered for sale. If, however, the building - BUILDING: TYPE CONST: OCG: GRP. Electrical giy ' of proving that he did not build or improve for the purpose of sale.) Address' 1i 54-445 Hountain Shadows struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner o/ who builds or improves thereon, and who for , $.25, property contracts •+ such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) .S.M.I. •< .. Grading A.P. Number •- City 3�2.. {3t�Tt�r=s , f.�z53 Zip ITel._ •• Legal Description + Contractor` Al Durrett Construction I hereby affirm that I have a certificate of consent to self -insure, or a certificate of Project Description 16cteY3or rens el F t Address Policy No. Company Copylflied with the city. ❑ Certified copy is hereby furnished. f P.O', Box 3371 REMARKS WORKERS' COMPENSATION INSURANCE / / (This section need not be completed if the permit is forione hundred dollars ($100),ivaluation CityPa.1m Desert,, Ith 92261 Tel. 564-3673 Laws of California.;':Tt f r d, r ` * . ,: ! r„` ., State Lic. & Classif. $ 41035 City Lic. # 146.3 Sq. Ft. -No. °- • : No. Dw. Arch., Engr., Minimum Setback Distances: ' _'�• �”- - - - Front Setback from Center Line Size Stories Units Designer Gorden Stein- I hereby affirm that there is a construction lending agency for the performance of the New ❑ Add ❑ Alter ❑ Repair ❑ -Demolition ❑ Address r 'Tel. f/, FINAL DATE INSP CTOR This is a building permit when properly filled out, signed and validated, and is subject to w City Zip State f Lic. # V LICENSED CONTRACTOR'S DECLARATIONa• I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section' 0000) of Division 3 of the Busmess'and Professions Code, and my license is in full force and effect.,,. i SIGNATURE r DATE'+ DECLARATION OWNER -BUILDER from I hereby affirm that I am exempt from the Cont'ractor's License Law for the following Estimated Valuation $12 $ C.30Q AA . . reason: (Sec. 7031.5,Business and Professions Code: Any city ofcountywhich requires a, permit to construct, alter, Improve, demolish, or repair any structure, I prior to its issuance also • requires the applicant for such permit to file a signed statement that he Is licensed pursuant to .PERMIT - - - AMOUNT the provisions o/ 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 o/ Section 703 1. 5 by 'any applicant for a permit . Plan Chk. Dep. - 'subjects the applicant to a civil penalty of not more than five hundred dollars ($500). Plan Chk. BBI. - - 93.60 ❑ 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 Const. 4 �'� ` 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, Mech. - provided that' such improvements are not intended or offered for sale. If, however, the building - or improvement is sold within one year o/ completion, the owner -builder., will have the burden Electrical giy ' 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- Plumbing struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner o/ who builds or improves thereon, and who for , $.25, property contracts •+ such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) .S.M.I. •< .. Grading ❑ I am exempt under Sec. B. 8 P.C. for this reason Driveway Enc. Date owner Infrastructure 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 Copylflied with the city. ❑ Certified copy is hereby furnished. f TOTAL CERTIFICATE OF EXEMPTION FROM ,� REMARKS WORKERS' COMPENSATION INSURANCE / / (This section need not be completed if the permit is forione hundred dollars ($100),ivaluation or less.) .' :V I certify that in the performance of thp;work for,.which this permit is issued/s`ha11 not employ,any,'' erson,in any manner so as to become,subject to the Workers' Compensation Laws of California.;':Tt f r d, r ` * . ,: ! r„` ., Pate/ '*-V 'Owner e # •1� • »r:.r..�_. '%NOTICE.TO APPLICANT: this Certificate of,"Exemption you should become ZONE: - BY: elf„after*making subject to the workers' Compensation provisions of the (Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. Minimum Setback Distances: ' _'�• �”- - - - Front Setback from Center Line Rear Setback from Rear Prop. Line CONSTRUCTION LENDING AGENCY Side Street Setback from Center Line 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.) Side Setback. from Property Lia ' Lender's Name r Lender's Address f/, FINAL DATE INSP CTOR 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 certify that I have read this application and state that the above information is correct. -Issued by: - Date ir eTirTt{t I agree to comply with all city and county ordinances and state laws relating to building rr construction, and hereby authorize representatives -of this city to enter the above-. �� 11►7Q mentioned property for inspection purposes. Validated by: 1►`j Signature of applicant Date •V Mailing Address Validation: ° �'�•_ City, State, Zip CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SO. FT. ® $ UNITS SLAB GRADE a 2ND FL. SO. FT. BONDING YARD SPKLR SYSTEM POR. SO. FT. ® MOBILEHOME SVC. BAR SINK GAR. SO. FT. ® POWER OUTLET ROOF DRAINS CAR P. S0. FT. ® GAS (ROUGH) DRAINAGE PIPING WALL SO. FT. ® OTHER APPJEOUIP. DRINKING FOUNTAIN SO FT ® TEMP. POLE URINAL ESTIMATED CONSTRUCTION VALUATION $ GROUT WATER PIPING NOTE: Not to be used as property tax valuation FINAL INSP. FLOOR DRAIN MECHANICAL FEES WATER SYSTEM WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER FINAL INSP. GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED LAUNDRY TRAY 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 ® 11/4 c SEWAGE DISPOSAL GAR. FIREWALL SO.FT.GAR @ 3/ac HOUSE SEWER LATHING 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 FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL