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9906-049 (SFD)~+�-^'°���`^-'~^ . ' LICENSED CONTRACTOR DECLARATION P.j�herebyiaffirm under penalty of perjury that I am lic ' ensed under provisions of CKapter 9 (commencing with Section 7000) of Division 3 of the Business and -'P(ofessionals Code, and my License is in full force and effect. I License # Lic. Class Exp. Date 13 JkDateK Signature of Contractor OWN ER-BUI LDER. DECLARATION I hereby affirm under penalty of perjuryffiat I am exempt from the Contractor's Ocense Law for the following reason: 1, 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, Business & Professionals Code). 1, as o%�ner' of the prop_,�rty'-. anN exclusiV6'ly `contracting with licensed contractors to construct the pr6jec't,'(`§ec. 7044, Business &eProfessionals Date Signature of Owner."' WORKER'S COMPENSATION. DECLARATION I hereby affirm under penalty -of perjury one',of'the following declarations: I have ahcl, will maintain a certificate of consent to self -insure for workers� compensation, as provided for by Section '3706 of the, Labor Code, for the performance 6f the' work for which this permlit is' issded..-.'�c - I .. ��ave and will mairitain"w6rkers' compensation. insurance, as required by S.ebtfon '3700 'of the Labor Code, for the performance of the, work for which. this perm I it'is issued. My workers'' Compensation in . sura . nce carri�r*& policy' no.- are: Cartier (This section need not be completed if the permit, valuation is for $100.00 or less). I certify that in the'performance of th6 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-, and agree that if I should become subject to the workers' compensation provisions of Section 3700 of,the Labor :�Warning::F'ailure'to securePorkers' Compensa'tio'n coverage is unlawful and shall subject an employerto criminal penalties and civil fines up to $100,000, in addition to the cost of compensation, damages as provided for. in Section 8706 of the Labor Code, interest and attorney's fees. IMPORTANT Application is hereby,made to the Director of Building and Safety for. a permit subject -to the conditions and,.r6stricti6ns set forth on his 1. Each person upon whose b�half this application is made & each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this applicaton agrees to, & shall, indemnify & hold »ann|oo��the City of uo Quimaha officers,mo mg employees. � u. Any permit issued aua result ofthis application becomes null and void if work is not commenced within. 180 dovo from dam of issuance of,vuoh permit, or cessation of work for 180 days will subjectpermit to cancellation. | certify that, | have mad this application and state that the above information is correct. | ageeeoioo���with �|C�Karid G�m�wum�Ungm8mbuilding construction, and hereby authorize representatives o/this City to omo,upon the. above- mentioned p'npe'` i ~-voo. V"--'- `---=—` -Date � I-, BUIONG PERMIT 9,904-049 DATE- 'VALUATION L - TRACT _q S180,349.60 9T 278 461 41 Jo ,ADDRESS 4 1_64VLA.M0114TANIA OWNER CONTRACTOR DESIGNER ENGINEER WIDBR0010401,1�6WDRJVE, SUITE 208 1570 BR.CbK1-10LL0W OWNS, S-UTIE 208 SxWrfit ANA CA 92705 $ANTik ANA. CA 90_70� (714)751-915'1 C 0 44W5 USE OF PERMIT MO LR FAMILY DWELLINO "ION v 3,018.00 SF 642.00 SF PERMIT FER'SUMAIARY TIM -1 D04110337 .10-1;�W0789�41118 _rZ54.00 SIR 550 ourgoia viit­ 101-M-423'-000 s.20 4V 12 XOT 'NOW V"--'- `---=—` -Date � I-, INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings Ducts Slab Grade _ t k17Return Air Steel Combustion Air Roof Deck — 7 Exhaust Fans O.K to Wrap - Q5Z F.A.U. Framing Compressor Insulation 4 Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath c8. Q S, ?. • K Final Final .�. .. BLOCKWALL APPROVALS Steel POOLS - SPAS Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Plbg. Test Final Gas Piping PLUMBING APPROVALS Gas Test Electric Final Waste Lines Heater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection — Encapsulation Gas Piping Gas Test $ Appliances Final Final Utility Notice (Gas) ELECTRICAL APPROVALS Temp.yower Pole Underground Conduit Rough Wiring Low Voltage Wiring Fixtures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) /. , COMMENTS: Building Address �J / � / C) S j % 1 b V Owner Co \10 C4 0%-A \ CO 0 TAh I. f4-40"-.. . AMPICO 71g. P.O. BOX 1504 18_"95 CALLE TAMAPPLICATION ONLY ,¢ LA QUINTA, CALIFORNIA 92253 Mailing Address 1570 &60kG ollo��6d City l. Zip 0 Te% 174-71S�1)51 ress ,. Zip ITel.. State Lic.C� City & Classif. 59 156 p g Lic. # Arch., Engr., Designer Address Tel. City (Zip ( State I Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing with Section 70001 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 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) 1] 1, 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 Lew 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 buildor improve for the purpose of sale.) H 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.contractor(s).licensed pursuant to the Contractor's License Law.) 1-1 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 n 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 the 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: d, 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. 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 a0plicanl Date Mailing Address City, State, Zip BUILDING: TYPE'CCONST. OCC. GRP. A.P. Number (PA -3-12-0-050 Legal Description Lot � � 7 � � � � X615 a Project Description S 5 50Ah N G 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 Validated by: Validation: WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION Sq Ft. No. Size 1 I - Stories No. Dw. Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation PERMIT ' AMOUNT Plan Chk. Dep: 2SO --C Plan Chk. Bal. Const. 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 FINAL DATE INSPECTOR Issued by: Date Permit Validated by: Validation: WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION S V OF TN PUBLIC WORKS CLEARANCE LETTER FOR CUSTOM HOME LOTS Dear Builder: Prior to issuance of a building permit, you will be required to obtain clearance from the Public Works Department for one, or -more; of the following: 1. Verification that rough grading is complete, and the pad elevation certifications prepared by a licensed surveyor, or engineer, are on, file in the Public Works Department. 2. Verification that infrastructure improvements and other required tract improvements are complete, or sufficiently advanced to warrant building permit issuance. 3: Prepare an engineered grading plan that provides for on -lot storm water retention, and have it checked and approved by the Public Works Department. • Tract..26524 (Estancias) • Tract 26769 (Mountain View Estates) •4. Prepare an engineered grading plan that .provides for building pad grading in accordance with the ' existing soils report and tract grading plan, and have it checked and approved by the Public Works Department. • Tract 28034 (South Valley Estates) FOR INTERNAL USE BY PUBLIC WORKS DEPARTMENT /17 TRACT: ly;) LOT: �4h� PUBff WORK LITHO IZATION DATE F:IPWDEPTIDOCS\FORMSkPW CLEARANCE LEITER.ss COMMENTS: