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12196 (MISC)Building 54-660 Shoal. Creek, Address Owner Kenneth E. Delaney Mailing Address Same City Zip Tel La Quinta, CA 92253 Contractor Southwest Concepts Address 82--723 Dr. C,?arreon C.€a ao, CA Zlp 92201 1 Tel P.O. BOX 1504 78-105 CALLE ESTADO LA QUINTA, CALIFORNIA 92253 BUILDING: TYPE CONST A.P. Number 561-2969 [Legal Description State Lic. I Cit yr I! i & Classif. B 523887 Lj`c. # 1 .../ (r Designer Address Tel. City Zip State Lic. # ,,/ CEN DECLARATION J hereby affirm th s�/I m lice ed under pr ov' io�rs pp Chapter 9 (commencing with Section 000) of Division 6 e Bu ness a 0- 10 and my tic�s�eJs in ILfor .e1an,Q effect f/� / I ��li(`/ tid/(s. :t. 7Vii ,✓ OWNER -BUILDER DECLARATION I hereby affirm that I 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 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 thathe is exempt therefrom, and the basis for the alleged exemption. Any violation of Section 7037.5 by 'any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (S500). ❑ 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. h, 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 safe.) ❑ 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 Conrractor's License Law.) 0 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 No. Company ❑ Copy is filed with the city. ❑ Certified copy is hereby furnisied. CERTIFICATE OF EXEMPTION FROM WORKERS'COMPENSATIONINSURANCE (This section need not be completed if the permit is for one hundred dollars (5100) valuation or less.) t� I certify that in the performance of0t work or which this permit�'s issued, I shall not employ any person in any manner s bac me su' ' ct to h W6fkers' Compensation Laws o al' r , /jl, ate ��J Owner '/f OTICE TO APPLICANT: It, after makin this Cerfificale o Exemption you should become subject to the Workers' Co�ation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code.) 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. 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 Project Description No. 12196 _OCC`. GRP. - Skylight Sq. Ft. No. No. Dw. .,Size Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation $450.00 PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. Const. 30.00 Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure TOTAL 30.00 REMARKS ZONE: BY: Minimum Setback Distances: Front Setback fro entef�`iFf� Rear Setback fro ear Prop. Line_ Side Street Setba keym Center Line F Side Setback from tae FINAL DATE INSPECTOR Issued by: Date Permit Validated by: Validation: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING rFES 1ST FL. SO. FT. ® $ UNITS COLL. AREA { ROUGH PLUMB. YARD SPKLR SYSTEM 2ND FL. SO. FT. HEATING (ROUGH) STORAGE TANK FORMS MOBILEHOME SVC. BAR SINK POR. SQ. FT. ® DUCT WORK ROCK STORAGE GAR. SO. FT. Q POWER OUTLET ROOF DRAINS METER LOOP HEATING (FINAL) DRAINAGE PIPING CARP. SO. FT. ® GAS (FINAL) WALL SQ. FT. DRINKING FOUNTAIN. GROUT WATER HEATER URINAL SQ. FT. ® FINAL INSP. ESTIMATED CONSTRUCTION VALUATION $ WATER SYSTEM WATER PIPING NOTE: Not to be used as property tax valuation GRADING cu. yd. $ plus x$, FLOOR DRAIN MECHANICAL FEES WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER / 6-V GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED REMARKS: 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. SO. FT. ® c BATH TUB SQ. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SQ. FT. RESID ® 11/4 c SEWAGE DISPOSAL SQ.FT.GAR ® 3/ac HOUSE SEWER MESH 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 APPJEOUIP. 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 / 6-V jam / REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATIONISOUND FINISH GRADING INAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL fr• AV 2710 oc.(SXISj'j 4& 73 -7 HAWSM b�1-2x10 240 G.T.Co r ��fCTIJGH T NE Al LA QUINTA. PLANNING CEEVE UN RudENT DNT rr- B U I L D - f 271 �� Its- fi'f 13A ACCEPTED ;� -� ��'�� '��®� �,�. F� SEJB�E:.T TO INSTALLATION ASPER lo 07 "XX f� / ND ALL APPLICABLE C / . DATE / R .. � 11 - r� •�fi �Y�. .�°' �-ST��-STI O� � . 16417 EE1M I NCS M- l 1 ' ?SIV- CHar1�� iS •,� � IN Af 2253 -TAW , P- /°1°13