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15190 (BLCK)4-4 r` P.O. BOX 1504 N o . 15190 Building 78-=120 Calle Tampico 78-495 CALLE TAMPICO �•. Address LA QUINTA, CALIFORNIA 92253 Owner Robert Cunard Mailing Address P.O. Box 1264 City Zip . Tel. La'Quinta " 32253 564.3660 Contractor owner/builder Address & Classif. I Lic. # Arch., Engr., Designer Address Tel. City Zip State Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that 1 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 Contractors 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 file a signed statement that he is'licensed pursuant to the provisions of the Contractor's License Law, Chapter 9 (commencing with Section. 7000) or Wfslon 3(of the Business and..P.rofessions•Code, or that. he is exempt therefrom, and the basis loi the alleged, exemption.-, ny violatkm of_ Section 7031.5 by 'any applicant fora permit )'sybjects the applicant to a civil penalty of not more than Five hundred dollars ($500)., 7 1, as owner of the property, or my employees with wages as their sole compensation, will do he 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 knprove for the purpose of sale.) O I, as owner of the property, am exclusively contracting with licensed contractors to con- struct the project. (Sec. 7044, Business and.Professlons 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 Sea . f B. 8 P.C. /or this reason �t r A 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 0 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 ($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 - BUILDING: TYPE CONST. OCC: GRP. A.P. Number Legal Description Project Description 201 ©f . 421 <Iarden block wa l l 43' of 58 garden block wall NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become ZONE: BY: subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shalt be deemed revoked. Sq. Ft. Size " • No. _-' Stories No. Dw. Units New ❑ Add ❑ " Alter ❑ Repair.❑ Demolition ❑ " Rear Setback fro f� ar p. 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 Street Setba rom, rt I n e HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, Side Setback ff • r0 e . , e p DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. t �/// I . J 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. FINAL DATE INSP`CxQFi I certify that I have read this application and state that the above information is correct. Estimated Valuation � 2,441.00 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-. PERMIT AMOUNT Plan Chk. Dep. Signature of applicant Date- ate Plan Chk. Bal Mailing Mailing Address Const. !)� • UV Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure TOTAL 4tt • REMARKS Date Owner . NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become ZONE: BY: subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shalt be deemed revoked. Mlrllmum Setback Distances: - Front Setback from enter Line Rear Setback fro f� ar p. 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 Street Setba rom, rt I n e HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, Side Setback ff • r0 e . , e p DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. t �/// I . J 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. FINAL DATE INSP`CxQFi I certify that I have read this application and state that the above information is correct. 1SSUed by: Date l A P.e - rta,. 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-. �!J ��\v mentioned property for inspection purposes. Validated by: Signature of applicant Date- ate Mailing Mailing Address Validation: City, State, Zip CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBINU FEES IST FL. SO. FT. ® $ UNITS COLL. AREA SLAB GRADE ROUGH PLUMB. Y ARD SPKLR SYSTEM 2ND FL. SQ. FT. p HEATING (ROUGH) STORAGE TANK FORMS MOBILEHOME SVC. BAR SINK POR. SQ. FT. ® 'DUCT WORK ROCK STORAGE GAR. SO. FT. ® POWER OUTLET ROOF DRAINS METER LOOP HEATING (FINAL) DRAINAGE PIPING CAR P. SQ. FT. ® GAS (FINAL) WALL SQ. FT. ® DRINKING FOUNTAIN • SO. FT. ® WATER HEATER URINAL ESTIMATED CONSTRUCTION VALUATION $ FINAL INSP. WATER PIPING NOTE: Not to be used as property tax valuation WATER SYSTEM FLOOR DRAIN MECHANICAL FEES GRADING cu. yd. $ plus x$ WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER FINAL INSP. GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED � / J LAUNDRY TRAY AIR HANDLING UNIT CFM REMARKS: 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 SO. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SQ. FT. RESID ® IIA c SEWAGE DISPOSAL SQ.FT.GAR ® Wac 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 � / J REMARKS: VENTILATION FIRE ZONE ROOFING ' FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATIONISOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURES/INITIALS GARDEN WALL FINAL