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002497 (RR)Building 54—SIO AM.& Juarez Address Owner Owin KZX=j0 Mailing Address 43-870 V. J'aCkF.= City Zip Tel. �rx3w " 92201 Contractor ress jZip - .. ITel P.O. BOX 1504 78-105 CALLE ESTADO LA QUINTA, CALIFORNIA 92253 State Lic. City & Classif. Lic. # Arch., Engr., Designer " Address Tel. CityT ip State Lic. # LICENSED CONTRACTOR'S DECLARATION, I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect.. _ SIGNATURE 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. atter, 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 penalty of not more than rive; hundred dollars' (3500). " •- - O 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 ofpropertywho 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 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.) ❑ 1 am exempt under Sec. B. & P:C. for this reason• Date Owner Y .i3�!L- ✓ �� - s %.�et.�' G 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 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. Date Owner NOTICE TO APPLICANT: If, after making this Certificate or 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 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. 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 ins ection purposes. - l ) Signature of applicant % ! fiy�'�+fDate Mailing Address if City, State, Zip HARD COPY No. 002497 BUILDING: TYPE CONST. OCC: GRP. A.P. Number Legal Description Project Description' ZONE: BY: Minimum Setback Distances: Front Setback from Center Line Sq. Ft. Size No. Stories No. Dw. Units ' New ❑� Add ❑ Alter ❑ Repair ❑ Demolition ❑ FINAL DATE INSPECTOR Issued by: Date Permit Validated by: Validation: A6G53 7 25 20.00 CK Estimated Valuation }}gy�n/� 800 a Vit PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. Const:. Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure TOTAL REMARKS 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 FINAL DATE INSPECTOR Issued by: Date Permit Validated by: Validation: A6G53 7 25 20.00 CK CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SQ. FT. ® $ 2ND FL. SQ. FT. POR. SQ. FT. ® GAR. SQ. FT. ® CAR P. $Q. FT. WALL SO. FT. ® SQ. 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 FLOOR DRAIN MECHANICAL FEES HEATING (ROUGH) WATER SOFTENER VENT SYSTEM FAN EVAP.000L HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER DUCT WORK GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED LAUNDRY TRAY AIR HANDLING UNIT CFM HEATING (FINAL) 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. SQ. FT. ® c BATH TUB BOND BEAM SQ. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SQ. FT. RESID ® 11/4 c SEWAGE DISPOSAL LUMBER GR. SQ.FT.GAR ® 3/ac HOUSE SEWER FRAMING FINAL INSP. GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE DBL TOTAL FEES MICRO FE7 MECH.FEE PL.CK.FEE CONST. FEE ELECT. FEE SMI FEE --j 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 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 REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL .'� LATHING MESH INSULATION/SOUND FINISH GRADING s NAL INSPECTION s CERT. OCC. FENCE FINAL INSPECTOR'S SIG NATURESIINITIALS, GARDEN WALL FINAL