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09087 (PLBG)4 - 4v Qs, P.O. BOX 1504 7&105 GALLS ESTADO .8 AVER I0© CORTE8 LA QUINTA, CALIFORNIA 92253 & MRS, IGNACIO DE LA TOERE Address City Contractor Aaaress '. 0. BOX 1908 & Classif. 254184 Arch., Engr., Desidner Zip p Tel. # 194 City, I Zip I State Lic. # LICENSED CONTRACTOR'S DECLARATION Lhereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000)t. of Division 3 of the 'Business d'1390essio s Code, and my license is in full force and effectt� ..- t F 11 J i b, SIGNATuR /V rJa G7' DATE OWNEA•BUILDER DECLARATION I hereby affirm that I am exempt from the Contractors License Law for the following .reason: (Sec. 7031.5,BusineSSL 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 tile a signed statement that he is licensed pursuant to �Ne provfslons of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of fNvision 3 o the. Business and Professions Code, or that. he, Is exempt therefrom; and the basis for the lalleged exemption. Any violation of Section 703.1.5 by any applicant for a permit • subjects the applicant to ac/Wl.penalty ofnot more than Bve hundred dollars($500). 0 I, as owner of the property, or my employees with wages as their sole compensation, will doAhe work, and the structure Is not intended or offered for sale. (Sec. 7044, Bulaness and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or Improves thereon and who does such work himself or through his own employees, provided that'such Improvements are not intended or offered for sale. ft', however, the building or Improvement Is sold within one year of completion, the owner -builder will have the burden of proving that he dM not build or improve: for the purpose.of sale.) 0 I, as owner. of the property, am exclusively contracting with licensed contractors to con- struct .the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or Improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's. License Law.) 0 1 am exempt under. Sec. B. & P.C. for this reason 'Pate Owner WORKERS' COMPENSATION DECLARATION I. hereby affirm that I have a certificate of consent to self -Insure, or,a certificate of 'Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.), Poll {� Company �z=� �4H$ (copy s led with he city. ❑Certified copy Is hereby fumished. 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 the work for which this permit is Issued, I shall not employ. any Californiapperson in any manner so as to become subject to the Workers' Compensation Laws of . Date Owner NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become subject to Me Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provision or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY 1hereby affirm, that there Is a construction' lending agency for the performance of the work for which this permit Is Issued. (Sec. 3097, Civll,Cods.) 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. Lagree 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 Malling-Address City, State, Zlp No. 09497 SE6TEa HOOKUP BUILDING: TYPE CONST. A:P. Number 774-142-005 Legal Description Project Description atawar h,otinknTs OCC: -GRP.: Sq. Ft. Size • • No. Stories No. DW.1. Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation PERMIT AMOUNT Plan Chk. Dep. . Plan Chk. Bal. Const. Mech. Electrical Plumbing '81:30,00 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: T CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SO. FT. UNITS SLAB GRADE 2ND FL. SQ. FT. YARD SPKLR SYSTEM POR. SQ: FT. ® MOBILEHOME SVC. BAR SINK GAR. SO. FT. ® POWER OUTLET ROOF DRAINS CAR P. SQ. FT. ROCK STORAGE DRAINAGE PIPING WALL SQ. FT. DRINKING FOUNTAIN. SQ. FT. ® HEATING (FINAL) URINAL ESTIMATED CONSTRUCTION VALUATION $ GAS (FINAL) WATER PIPING NOTE: Not to be used as property tax valuation FLOOR DRAIN MECHANICAL FEES GROUT WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED LAUNDRY TRAY AIR HANDLING UNIT CFM GRADING cu. yd. $. plus x$ 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 VENTILATION SQ. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U- SQ. FT. RESID 1% c SEWAGE DISPOSAL SQ.FT.GAR 3Ac HOUSE SEWER 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 APPJEQUIP. 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' (/ l/7 / v /YM+ REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATION/SOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESlINITIALS GARDEN WALL FINAL