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14803 (RPL)Building Owner %- 4 Qgm& P.O. BOX 1504 No. 14803 78-495 CALLE TAMPICO 53--170 "e. Diaz LA QUINTA, CALIFORNIA 92253 Sterling Homes 7771ILDING: TYPE CONST. OCC. GRP. Address P.O. Bear 450 City Zip Tel. La Quinta, CA 92253 564--1866 Contractor pLendel Ventukes gSame s City Zip Tel.: State Lic. City & Classic' B 638535 Lic. # $59 Arch., Engr., Designer Address I Tel. City Zi State / P Lic. # d LICENSED CONTRACTOR'S DECLARATION _ . , I hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of.the Business and Professions Code, and my,iceennse is in full force and. effect: �� V�:`�� '``'•�iTS:c _ '�' �w ' ! ��. jv OWNER -BUILDER -DECLARATION?' f_1P4„S , I hereby affirm that 1 am exempt from the Contract9 License Law for the following reason: (Seafi 7031.5,Business and Professions Code::Ehy city or county which requires a permit to,(coristruct, after, improve, demolish, or repair Adinry structure, prior to -.its issuance also requirestthe applicant for such permit to rile a signed�tatement that he is licensed pursuant to the provisions of the Contractor's License Law, CAApter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, of 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 rive 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 wile have the burden of proving that he did not build or improve for the purpose of 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) Ucensed 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 ❑ Copy is filed with the city. ❑ Certified copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM WORKERS'COMPENSATIONINSURANCE (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 any manner so as to become subject to the Workers' Compensation Laws of California. Date Owner 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. ' 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 property filled out, signed and validated, and is subject to expiration it work thereunder is suspended for 160 days. I certify that 1 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. A.P. Number Legal Description Project Description Reduction of "Pool rear -and side yard setbacks approved per SBA 95- Sq. Ft. Size No. No. Dw. Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation- $10,000.00 PERMIT AMOUNT Plan Chk. Dep. -- Plan Chk. Bal. 76.05. Const. 117.00 Mech. 24.00 Electrical 45.00 Plumbing 27.00 S.M.I. Grading Driveway Enc. Infrastructure TOTAL 289.05 REMARKS ZONE: BY: Minimum Setback Distances: Front Setback from Center Line Rear Setback from Rear Pr9P141,ine Side Street Setback from e 'ne Side Setback from ProVine FINAL DATE 1 Issued by: Date_ Validated by: Signature of applicant— Date Mailing Address Validation: City, State, Zip .IN CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBIW FEEY �1 1ST FL. SO. FT. ® $ UNITS �. 2ND FL. SQ. FT. ® ROUGH PLUMB. YARD SPKLR SYSTEM_ BONDING MOBILEHOME SVC. BAR SINK POR. SO. FT. ® SEWER OR SEPTIC TANK GAR. SQ. FT. ® POWER OUTLET ROOF DRAINS FOUND. REINF. GAS (ROUGH) DRAINAGE PIPING CAR P. SO. FT. HEATING (FINAL) OTHER APPJEOUIP. WALL SO. FT. GAS (FINAL) DRINKING FOUNTAIN SO. FT. ® URINAL ESTIMATED CONSTRUCTION VALUATION $ WATER HEATER WATER PIPING NOTE: Not to be used as property tax valuation FINAL INSP. FLOOR DRAIN MECHANICAL FEES WATER SYSTEM WATER SOFTENER VENT SYSTEM FAN EVAP.000L HOOD SIGN WASH ER(AUTO)(DISH) APPLIANCE DRYER GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED ROOFING LAUNDRY TRAY AIR HANDLING UNIT CFM KITCHEN SINK ABSORPTION SYSTEM B.T.U. TEMP USE PERMIT SVC WATER CLOSET' COMPRESSOR HP POLE, TEMIPERM LAVATORY HEATING SYSTEM FORCED GRAVITY AMPERES SERV'ENT SHOWER BOILER B.T.U. SO. FT. ® c BATH TUB SQ. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SQ. FT. RESID a l Va c SEWAGE DISPOSAL SQ.FT.GAR Q• 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 GROUND /6 S 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 /" I" FINAL INSP. GRADING cu. yd. $ plus x$ =$ LUMBER GR. FRAMING FINAL INSP. ROOFING 311 REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATIONISOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL