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14702 (BLCK)44 ' P.O. BOX 1504 No. 14702 Building78-495 CALLE TAMPICO Address S4—' 34 Shoal Creek LA QUINTA, CALIFORNIA 92253 Owner Rancho Ca astrww Mailing Address City Zip ITel. Contractor Desert Sand Cont. Kent Rath 42--151 Sandy Box Rd. uda Dunes zip 32202 Tel 345-5490 State Lic. City & ClassifC29 488833 Lic. # 686 Arch., Engr., Designer Address Tel. City I Zip I 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 OWNEWBUILDER DECLARATION 1 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_lhe Contractor's License Law, Chapter 9 (commencing with Section. 7000) of Division 3 o/ 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.theirsole compensation, will do the work, and the structure is not intended or offered for sale. (Sec. 7044, Suisness 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 or improve for thepurposeor 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) pcensed 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 1 have a certificate of consent to self -insure, or a certificate of _ Workers Compensation Insurance, or a certified copy.thereof. (Sec. 3800, Labor Code.) Policy No. Company O 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. 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 shall 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 AT'TORNEY'S FEES. li 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. i, • . 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 ate Mailing Address City, State, Zip p BUILDING: TYPE CONST. OCC. GRP. A.P. Number Legal Description Block Walls Project Description 110, 0.69 Garden ?41all REMARKS ZONE: BY: Minimum Setback Distances: Front Setback from Center Line Rear Setback from Rear ProliLihe Side Street Setback from Center'Line. Side Setback from Propedy/Line FINAL DATE INS ECTOR��`- v� " Issued by: Date `L Per it V `" Validated by: \\ ,`99n !� ` Validation: Sq. Ft. Size No. Stories No. Dw. Units - New ❑ Add.❑ . Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation '21500.00 PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. $54.00 Const. Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure TOTAL • t� REMARKS ZONE: BY: Minimum Setback Distances: Front Setback from Center Line Rear Setback from Rear ProliLihe Side Street Setback from Center'Line. Side Setback from Propedy/Line FINAL DATE INS ECTOR��`- v� " Issued by: Date `L Per it V `" Validated by: \\ ,`99n !� ` Validation: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBINU FEES 1ST FL. SO. FT. ® $ UNITS SLAB GRADE ROUGH PLUMB. BONDING YARD SPKLR SYSTEM 2ND FL. SO. FT. FORMS SEWER OR SEPTIC TANK ROUGH WIRING MOBILEHOME SVC. BAR SINK POR. SO. FT. ® GAS (ROUGH) METER LOOP GAR. SO. FT. ® POWER OUTLET ROOF DRAINS GAS (FINAL) TEMP. POLE DRAINAGE PIPING CAR P. SO. FT. ® GROUT WATER HEATER WALL S0. FT. FINAL INSP. DRINKING FOUNTAIN. SO. FT. ® \ . URINAL ESTIMATED CONSTRUCTION VALUATION $ =$ WATER PIPING NOTE: Not to be used as property tax valuation FINAL INSP. FLOOR DRAIN MECHANICAL FEES WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD . SIGN WASH ER(AUTO)(DISH) APPLIANCE DRYER GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED VENTILATION LAUNDRY TRAY AIR HANDLING UNIT CFM FIRE ZONE ROOFING ' 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. SO. FT. ® c BATH TUB LATHING SO. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 11/4 c SEWAGE DISPOSAL SO.FT.GAR ® 3/ac HOUSE SEWER FINISH GRADING 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. 2 P� GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APP.IEOUIP. 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 SIGNATURESlINITIALS GARDEN WALL FINAL