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06395 (RPL)P.O. BOX 1504 Building bpi -095 galea Court LA QUINTA CALIFORNIA 92253 Address .. Owner S= Address $ City Zip Tel. La Qui,nta 1 92253 Unique Foolis by Carmiva Address . 74-818 Velie Val #1 City lZip Tela State Lic. City & Classif. 5210432 Lic. # 1366 Arch., Engr., Designer Address Tel. City (Zip (State Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisionsof Chapter 9 (commencing with Section 7(lOp) of dv.��is^iion 3 of the Business and Professions Code and my licenseJn run fulYforce.and' effect. 1'�t�.,..t ,.t f � f � % � ''•�/ �� "`".-1"� DATE OWNER -BUILDER DECLARATION i I hereby affirm that I am exempt from the Contractors License Law for the following reason: (Sec. 703f.S,Business and Professions Code: Any city or county which requires a permit to construct, after, improve, demolish, or repair any structure, prior to its issuance also requires the applicant for such permit to life 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 ."Milan. 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 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 gnprovements are not intended or offered for safe. If, however, the building orimprovement is sold within one year of completion, the owner-buider wig 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 coir 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 Contractees License Law.) ❑ 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 Workers Compensation Insurance, or a certified copy thereof. (Sac. 3800, Labor Code.) Policy No. .Company ❑ Copy is filed with the city. ❑ Certified copy is hereby furnished. CERTIFICATE OF EXEMPnON FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed ff 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 =any person in any manner so as to become subject to the Workers' Compensation laws of California. Date Owner NOTICE TO APPLICANT. fi, after making this Certificate or 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 Ihereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code.) Lenders Name Lenders Address This is a building permit when properlyfilled 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 No. 45395 11LDING: TYPE CONST. OCC: GRP. P. Number Cactus nob er !gal Description oject Description P001 Sq. Ft. 330 No. No. Dw. Size "' Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated PERMIT Plan Chk. Dep. Plan Chk. Bal. Const. Mech. Electrical Plumbing S.M.I. AMOUNT 70.20 08.00 24.00 e30..00 27.00 .63 Driveway Enc. Infrastructure TOTAL REMARKS rknr:.401�1 4+kjo 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 9/26/89 Issued by: Date Permit Validated by: Validation: - CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES IST 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. I SO. FT. ® GROUT WATER HEATER WALL SO. FT. FINAL INSP. DRINKING FOUNTAIN BOND BEAM WATER SYSTEM URINAL SO FT ® _$ LUMBER GR. ESTIMATED CONSTRUCTION VALUATION $ FINAL INSP. WATER PIPING NOTE: Not to be used as property tax valuation FLOOR DRAIN MECHANICAL FEES WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED LAUNDRY TRAY AIR HANDLING UNIT CFM 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 SO. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 1% c SEWAGE DISPOSAL SO.FT.GAR ® VAc HOUSE SEWER GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEE MECH.FEE 111PL.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 ]. �y �L'%/G' (OI�AI//► I v` Ir r��U / REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATIONISOUND FINISH GRADING FINAL INSPECTION /® Zjr CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESlINITIALS � GARDEN WALL FINAL t