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10115 (ELEC)Iding Iress 53167 DIAZ VIVIAN MCCORMACK Mailing Address p• O MnV 241 L T,ityl 4 0P.O. 1504� 78-105 CALOLE ESTADO'\u LA QUINTA, CALIFORNIA 92253U s City Zip Tel. LA QUINTA 92253 Contractor OWNER BUILDER Address Tel.: - :e Lic. City lassif. I Lic. # Arcn., tngr., Designer Address I Tel. City( Zip ( 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,Buslness, 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 (E500). I, as owner of the property, or my employees with wages as their sole compensation, will 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..ff, however, the building or improvement Is sold within one year of completion, the owner -builder wig have the burden of proving that he did not build or improve for the purpose of 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) licensed pursuant to the Contractor's License. Law.) O 1 am exempt under Sec. B. & P.C. for this reason r . t j'Date, //-''r% Lj e 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. O 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 ($100) vafuation or less.) I certify that in the performance of the work for which this permit is issued, I shall not' employ any person in any manner so as to become subject -,to the Workers' Co pensation Laws of California. / / f' Date>Yt, t_/X/ Owner /_ll.ttr*� �.•,' �!.%tw ��/jiP�;.Es7 41 NOTICE. TO APPLICANT: If, after making this Certificate. of Exemption you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. r CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code.) Lender's Name Lender's Address This is a building permit when properly filled out, signed and validated, and is subject to expiration it work thereunder is suspended for 180 days. I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives -of this city to enter the above. mentioned property for inspection purposes. Signature of applicant Date Mailing Address City, State, Zip No. 10115 LDING: TYPE CONST. OCC: GRP. P. Number Description Description NEW ELECTRICAL BOR •i f i�t1;+t"SSi~4'lilf �� k'f`ii`$�A,,i � �•^�i7_.�a�!S fl� 4 {'/ 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: Sq. Ft. Size No. No. Dw. Stories Units New ❑ Add ❑ Alter ❑ Repair O 'Demolition ❑ Estimated Valuation $400 PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. Const.. Mech. Electrical $30.00 Plumbing S.M.I. Grading Y Driveway Enc. Infrastructure TOTAL $30.00 REMARKS •i f i�t1;+t"SSi~4'lilf �� k'f`ii`$�A,,i � �•^�i7_.�a�!S fl� 4 {'/ 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: STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR SETBACK CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES COLL. AREA IST FL. SO. FT. ® $ UNITS HEATING (ROUGH) STORAGE TANK FORMS SEWER OR SEPTIC TANK ROUGH WIRING. YARD SPKLR SYSTEM ROCK STORAGE 2ND FL. SO. FT. @ METER LOOP HEATING (FINAL) OTHER APPJEQUIP. REINF. STEEL GAS (FINAL) MOBILEHOME SVC. BAR SINK POR SO FT ® SERVICE FINAL INSP. GAR. SO, FT. ® POWER OUTLET ROOF DRAINS -$ LUMBER GR. FRAMING DRAINAGE PIPING ROOFING CAR P. Q. FT. ® REMARKS: WALLSO. FT. DRINKING FOUNTAIN. FIRE ZONE ROOFING SQ FT ® URINAL ESTIMATED CONSTRUCTION VALUATION $ WATER PIPING SPARK ARRESTOR NOTE: Not to be used as property tax valuation FLOOR DRAIN MECHANICAL FEES LATHING WATER SOFTENER VENT SYSTEM. FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER INSULATIONISOUND GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED LAUNDRY TRAY. AIR HANDLING UNIT CFM FINAL INSPECTION - KITCHEN SINK ABSORPTION SYSTEM B.MU. TEMP USE PERMIT SVC WATER CLOSET' FENCE FINAL COMPRESSOR HP POLE, TEMIPERM LAVATORY i HEATING SYSTEM FORCED GRAVITY AMPERES SERV ENT SHOWER BOILER. B.T.U. SQ. FT. a c BATH TUB SO. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID a 11/4 c SEWAGE DISPOSAL SQ.FT.GAR ® i4c HOUSE SEWER GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE DBL TOTAL FEES I MICRO FEE MECH.FEE JPLCK.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 APPJEQUIP. REINF. STEEL GAS (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM *FINAL INSP.�O GRADING cu. yd. $ plus x$ -$ LUMBER GR. 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 SIGNATURES/INITIALS GARDEN WALL FINAL i QU&rCV �oFn+t OWNER -BUILDER VERIFICATION Attention Property Owner: An owner -builder permit has been applied for in your name and bearing your signature. Please complete and return this information at your earliest opportunity to avoid unnecessary delay in processing and issuing your building permit. No building permit will be issued until this verification is received. 1. I personally plan to provide the major labor and materials for construction of the.proposed property improvement (yes or no) 2. I (have/have not) signed an application for a building permit for the proposed work. 3. I.have contracted with the following person (firm) to provide the proposed construction: Name _ Address Phone City Contractors License No. 4. I plan to provide portions of the work, but I have hired the following person to coordinate, supervise and provide the major work: Name Address City Phone - Contractors License No. 5. I will provide some of the work but I have contracted (hired) the following persons to provide the work indicated: (see attached) RPT1 OWN -BUILDER SIGNATURE