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15813 (RPL)f elr�� F o" 1 I9 P.O. BQX 1504 N o . 15 813 Address Building � �-2eS DESERT STRFJUd LA QUINTA, CALIFORNIA 92253 h v. GO.RWN WEST Mailing IBUILDING:, TYPE CONST. OCC: GRP. Address .4G-101t�3ESi�P.T Sa''RE?�[� 402 Cites zie253 TS2I60"1 403 ntractorTI14 GIL13ERT INC. Address 39--685 ST MICHAEL PL CityjPD %21 bid-�1$Q3 State Lic. 617723 Cit 73 & Classif.. Lic. Arcn., tngr., Designer Address Tel. CityI Zip I State Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby'rafji that I am licensed.under pJovisjor�seof Chapter 9 (commencing with Section D00) of D�Jiislon,3•of the-Bus`iness an -d Profeseions Code, and my license is in full force and OYNNE!kfBFUILOtR.DECLARATFON "^+ I hereby of}Irm that I am„exempt frorgdthe Contractoes License Law for the following reason: (Sec.7031.5?Business and Professions Code: Any city or county which requires a permit to, stroct�lker, Improve, demolish, or repair any structure, prior to its issuance also requires .1e22zplicant 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) or 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 penahy 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 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 dM not build or knprove for the purpose or sale.) O 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) (lcensed pursuant to the Contractor's 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 Worker's 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 comp !/gthe permit is for one hundred dollars ($100) valuation 'or less.) �j I certify that in the•perfonn#nce of thg wc*4ar which this permit is issued, I shall not - =anyemploy any person in any manner so,aa:tdbeco subjec .0jtbe- Workers' Compensation , Cal i Jia { ' Date Owner NOTICE TO,APPLICANT: 'fter,ma,” Mis Certificate or Exemption you should become subject to ,the Workers' Compensation prodsio sthe- Laboi Code, you must forthwith comply with such provisbnss;br this 'i m it shall be deeMg,ed 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 ATTORNEY'S FEES. 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 ateMailing Address City, State, Zip jA.P. Number_ ,Legal Description Project Description POOL ONLY z. Sq. Ft. Size No. No. Dw. Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ r 1 jJf Estimated Valuation Z• +� 8, Soo . ©t1 't.,, 4 PERMIT N AMOUNT Plan Chk. Dep. ` `4 Plan Chk. Bal. 1 , ►'� Const.`ti;,� Mech. 2 • 00 Electrical }" `!, j • 00 Plumbing ,, "+,'21.00. S.M.I. Grading # Driveway Enc. + Infrastructure TOTAL274.20 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 • k Issued by: Date Permit Validated by: Validation. i gy 3_. CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBIW FEES- 1ST FL. SO. FT. ® $ UNITS SLAB GRADE ROUGH PLUMB. //Y V J I YARD SPKLR SYSTEM 2ND FL. SO. FT. @ STORAGE TANK FORMS SEWER OR SEPTI MOBILEHOME SVC. BAR SINK POR. SO. FT. ® ROCK STORAGE FOUND. REINF. GAR. SO. FT. ® POWER OUTLET ROOF DRAINS OTHER APPJEOUIP. REINF. STEEL DRAINAGE PIPING CAR P. SO. FT. WALL SO. FT. WATER HEATER DRINKING FOUNTAIN SO. FT. ® URINAL ESTIMATED CONSTRUCTION VALUATION $ WATER PIPING NOTE: Not to be used as property tax valuation LUMBER GR. FLOOR DRAIN MECHANICAL FEES FRAMING WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER REMARKS: 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 ® 11/e c SEWAGE DISPOSAL MESH SO.FT.GAR ® 3/ac HOUSE SEWER INSULATION/SOUND 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. //Y V J I BONDING HEATIN STORAGE TANK FORMS SEWER OR SEPTI N ROUGH WIRIN DUCT WOJO 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 ' ,1 r REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATION/SOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURES11NITIALS GARDEN WALL FINAL