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12831 (BLCK)f lityl 4 P.O. BOX 1504 78-105 CALLE ESTADO ML;44-965 Tortola Circle LA OUINTA, CALIFORNIA 92253 P Williams/Miller ing ress Sade City Zip Tel. La Quints, CAI92253 345-8560 Contractor Owner/ElUild#. r Zip State Lic. I City & Classif. Lic. # Arch., Engr., Designer Address Tel. City I Zip I State Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I 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 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 that. he is exempt therefrom, and the basis for thealleged 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,rs 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. 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 the purpose or 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) licensed pursuant to the Contractor's License Law.) ❑ I am exempt under Sec. B. S P.C. for this reason r 1%!� Is Owner f 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 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 an manner so as to b comeesubJ'e t to the Workers' Com ensation XD.. aws of California; y � ✓ p te �" �Pwner '�� �- OTIr, after makirfg this Certificate of Exemption you should becomebject to the Workers' Compensalipn 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 BUILDING: TYPE CONST P. Number No. OCC: GRP. 12831 Legal Description Project Description 49 E of 316" high retaining wall 71 of 51 high.retaining walk. Sq. Ft. No. No. Dw. Size Stories - Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ f ' Estimated Valuation $816.00 PERMIT .I = AMOUNT Plan Chk. Dep. Plan Chk. Bal. Const. 7-� :.: p Mech. Electrical Plumbing 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 i/n �r FINAL DA Issued by: Validated Permit I I SETBACK GROUND PLUMBING UNDERGROUND CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES ROUGH PLUMB. BONDING HEATING (ROUGH) 1ST FL. SO. FT. ® $ UNITS SEWER OR SEPTIC TANK {' DUCT WORK YARD SPKLR SYSTEM 2ND FL. SQ. FT. Q GAS (ROUGH) METER LOOP HEATING (FINAL) MOBILEHOME SVC. BAR SINK POR. SQ. FT. ® TEMP. POLE �r GAR. SO. FT. ® POWER OUTLET ROOF DRAINS SERVICE FINAL INSP. DRAINAGE PIP NNG�� CAR P.' SO. FT. WATER SYSTEM WALL SQ. FT. DRINKING FOUNTA�'0) G FINAL INSP. URINAL �+ O SQ. FT. ® � y9Q O ESTIMATED CONSTRUCTION VALUATION $ WATER PIPING NOTE: Not to be used as property tax valuation VENTILATION FLOOR DRAIN MECHANICAL FEES WATER SOFTf .eR VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) FIREPLACE APPLIANCE DRYER GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED LAUNDRYTRAY GAR. FIREWALL AIR HANDLING UNIT CFM KITCHEN SINK ABSORPTION SYSTEM B.T.U. TEMP USE PERMIT SVC WATER CLOSET' MESH COMPRESSOR HP POLE, TEMIPERM 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. SO. FT. RESID ® 11/4 c SEWAGE DISPOSAL INSPECTOR'S SIGNATURESHNITIALS SQ.FT.GAR ® 3/ac 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 APP.IEQUIP. 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 INSULATIONISOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESHNITIALS GARDEN WALL FINAL