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14398 (PLBG)P.O. BOX 1504 Building51,,��© Ave. Velasco 78-495 CALLE TAMPICO Address LA QUINTA, CALIFORNIA 92253 Owner Mr. & Mrs. Terrance Sampson y Same Adydress . Quinta t CAI ZIps2253 Tel. Contractor. Denboer Eagi�aeering & Construction Adtfp175 $erro5 Cvialrt "" Cathedral Icily',', CA 92238'u'(619)327-.2 State Lic. City & Classif. A S 584563 Lic. # -Arch En Designer Address City Zip I herebyjaffirm that 1 am licensed unit Doo) of Division 3 -'of the Business and el. I State Lic. # �DECLARAT.ION of Chapter9 (commencing with Section Code, and my license isjin full force and . 1/ OWNER -BUILDER DECLARATION . I hereby affirm that I am exempt from the Contractor's License 'Law'for the following reason: (Sec. 7031.5,Bustness 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 file 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 penally of not more than rive hundred dollars (8500). . ❑ 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 or 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 orknprove for the purpose of sale.) ❑ 1, 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 ctintractor(s) (rcensed pursuant to the Contractor's License Law.) O 1 am exempt under Sec B. & P.C. for this reason 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 Flo. 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 N the permit is for one hundred dollars IS 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: N, after making this Certificate of; Exemption you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shaft 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 a building permit when properly filled out, signed and validated, and is subject to expiration if work thereunder is suspended for 160 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 inspection purposes. Signature of applicant Date Mailing Address City, State, Zip No. .14398 BUILDING: TYPE CONST. OCC -..GRP. A.P. Number Legal Description Project Description Sewer Connect Sq. Ft. No. No. Dw. Size Stories -Units New ❑ Add.❑ Alter ❑ Repair•❑ 'Demolition ❑ sated Valuation $1,r243.0( PERMIT Plan. Chk. Dep. Plan Chk. Bal. Const. Mech. Electrical AMOUNT 3Q.01Qv S:M.I. Grading Driveway Enc. Infrastructure TOTAL 30.00 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 i }} Validated by: Validation:. ' �i! % iir 1( p N CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING. FEES 1ST FL. SO. FT. ® $ UNITS SLAB GRADE 2ND FL. SQ. FT. p BONDING YARD SPKLR SYSTEM STORAGE TANK MOBILEHOME SVC. BAR SINK POR: SO. FT. ® DUCT WORK ROCK STORAGE GAR. SO.. FT. ® POWER OUTLET ROOF DRAINS HEATING (FINAL) OTHER APPJEQUIP. DRAINAGE PIPING -CARP. SO. FT. TEMP. POLE WALL SQ. FT. GROUT DRINKING FOUNTAIN SO. FT. ® FINAL INSP. URINAL ESTIMATED CONSTRUCTION VALUATION $ WATER SYSTEM WATER PIPING NOTE: Not to be used as property tax valuation . =$ FLOOR DRAIN MECHANICAL FEES 'FINAL INSP. WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASH ER(AUTO)(DISH) APPLIANCE DRYER GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED LAUNDRYTRAY 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. SQ. FT. ® c BATH TUB GAR. FIREWALL SQ. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SQ. FT. RESID ® 11/a c SEWAGE DISPOSAL SO.FT.GAR ® 3/ic HOUSE SEWER INSULATION/SOUND GAS PIPING PERMIT FEE FINISH GRADING 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 / R S ROUGH WIRING DUCT WORK ROCK STORAGE FOUND. REINF. GAS (ROUG ) 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 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