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14508 (BLCK)Building`;. Address `%-2551 CALT.P, m Owner LEON A. ATWOOD Mailing Address P, O BOX 1167 City lZip Contractor OWNER BUILDER' Address . • _ .. . EM City lZip .Tel. State Lic. I City & Classif.: Lic. # Arch., Engr., Designer Address Tel. 4 P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253- BUILDING: 2253 City Zip 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 1 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, alter, 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 five hundred dollars ($500). ❑ 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, 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 of property who builds or Improves thereon, and who contracts for such projects with a contractors) licensed pursuant to the Contractor's License Law.) ❑ 1 am exempt under•Sec. - B. & P.C. for this reason �4 Date "_-�--Owner- 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 ❑ 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 (8100) valuation or less.) - BUILDING: TYPE CONST. - OCC: GRP. A.P. Number Legal Description Project Description GAKIEA VA"L F, 41 FT . BY 6FT TALL ' employ any person in any manner so as to become subject to the Workers' Compensation Laws of California Sq. Ft. Size - No. No. Dw. Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ BY: subject to the Workers' Compensation provisions or the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. ' .-ZONE: Minimum Setback Distances: Front Setback from Center Line Rear Setback from. Regi? hop. Line WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE Side•StfeetSetback fr Ce�nterLine j�� HUNDRED THOUSAND DOLLARS ($100,000), IN.ADDITION TO THE COST OF COMPENSATION, ' Estimated Valuation{�� DAMAGES AS PROVIDED -FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND�I' PERMIT AMOUNT Plan Chk. Dep. 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. Plan•Chk. Bal. . 1 certify that I have read this application and state that the above information is correct. Const. I agree to comply with all city and county ordinances'and state laws relating to building construction, hereby Mech. and authorize representatives -of this city to enter the _ above-. mentioned property for inspection Electrical purposes. Plumbing Signature of applicant Date S.M.I. Mailing Address Grading City, State, Zip Driveway Enc. Infrastructure TOTAL 45. 00 REMARKS I certify that in the performance of the work for which this permit is issued,.) 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 -orExemption you should become BY: subject to the Workers' Compensation provisions or the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. ' .-ZONE: Minimum Setback Distances: Front Setback from Center Line Rear Setback from. Regi? hop. Line WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE Side•StfeetSetback fr Ce�nterLine j�� HUNDRED THOUSAND DOLLARS ($100,000), IN.ADDITION TO THE COST OF COMPENSATION, ' Side Setback from;PkJ erty." P�s,� DAMAGES AS PROVIDED -FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND�I' ATTORNEYS FEES. FINAL DATE I PEC"Tit�R lVl 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. -DateA davit . 1 certify that I have read this application and state that the above information is correct. Issued by: lav I agree to comply with all city and county ordinances'and state laws relating to building construction, hereby �� and authorize representatives -of this city to enter the _ above-. mentioned property for inspection -.,� purposes. Validated by: Signature of applicant Date ` Mailing Address Validation: V City, State, Zip CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SO. FT. ® $ 2ND FL. SQ. FT. POR. SO. FT. ® GAR. SO. FT. ® CAR P. SQ. FT. WALL SQ. 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 SLAB GRADE FLOOR DRAIN MECHANICAL FEES WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASH ER(AUTO)(DISH) APPLIANCE DRYER ROUGH WIRING GARBAGE DISPOSAL FURNACE UNIT W^LL FLOOR SUSPENDED DUCT WORK LAUNDRYTRAY AIR HANDLING UNIT CFM GAS (ROUGH) 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. SQ. FT. ® c BATH TUB WATER HEATER SO. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.—.U. SQ. FT. RESID ® 11/a c SEWAGE DISPOSAL BOND BEAM SQ.FT.GAR @ 3/4c HOUSE SEWER $ GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEE MECH.FEE PL.CK.FEE CONST. FEE JELECT.FEE SMI FE7 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.IEQUIP. 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. II ROOFING ZAge 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