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14835 (BLCK),t, g55 P.O. BOX 1504 N o . 14835 78-495 CALLE TAMPICO Address 54"-3 Ave. Riaz LA QUINTA, CALIFORNIA 92253 Owner Donald Hamilton Mailing BUILDING: TYPE CONST. - OCC: GRP. Address Bt x A.P. Number City Zip Tel. + ilig4La CA92253 . Legal Description ' Contractor 251 of ..5 1 high garden, owner/BuilderProject Description Address '40° of 411• high garden, and 35' of 4' 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 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 r' fir. Owner :.< r —V /-/.lf!':. r� e «✓E'.��.—. .. NOTICE TO APPLICANT: N, after making, this Certificate of Exemption. you -should become 17 tibf _t to the Workers' Compensation provisions of the Labor Code, you must forthwith mply 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 ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. - This Is a building permit when properly filled out, signed and validated, and is subject to expiration it work thereunder is suspended for 180 days. I certify that I have read this application and state that .the above information is correct. I agree to comply with all city and county ordinances and'state laws relating to building construction, and hereby authorizerepresentatives of this city to -enter the 'above-. mentioned property for Inspection purposes. Signature of applicant _ Date Mailing Address City, State, Zip REMARKS ZONE: BY: Minimum Setback Distances: Front Setback from Center Rear Setback from Rear Side Street Setback f Side Setback from Tty FINAL DATE SPEC Issued by: Validated by: Validation: Li high combination block -wall City' Zip Tel.: State Lic. & Classif. City Lic. # Sq. Ft. Size No. No. Dw. Stories Units � Arch., Engr., 'Designer New ❑ Add ❑ Alter ❑ Repair ❑ -Demolition ❑ Address Tel. City Zip State Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. SIGNATURE DATE OWNER -BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractor's License law for the following reason:. (Sec. 7031.5,Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance also requires the applicant for such permit to rile a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law, Chapter 9 (commencing with Section' 7000) of Division 3 of the Buslness and Professions Code. or that. he is exempt therefrom, and the basis for t je$ alleged exemption. Any violation of Section 7031.5 by 'any applicant for a permit sub acts the applicant to a civil penalty of not more than five hundred dollars ($500). t' 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, Bulsness 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 did'not build or improve for the purpose of sale.) p 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) (tcensed Pursuant to the Contractor's License Law.) - ❑ I am exempt under Sec- B. 8 P.C. for this reason �. Estimated Valuation Cs V o �0 - PERMIT - AMOUNT Plan. Chk. Dep. - Plan Chk. Bal. Const. 45. 00 Mech. Electrical Plumbing, , S -M -I: , Grading Driveway Enc. Date % J; 5; ; owner . '-el r ��f` ' � < < 9 Infrastructure 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. TOTAL 45.00 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 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 r' fir. Owner :.< r —V /-/.lf!':. r� e «✓E'.��.—. .. NOTICE TO APPLICANT: N, after making, this Certificate of Exemption. you -should become 17 tibf _t to the Workers' Compensation provisions of the Labor Code, you must forthwith mply 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 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 authorizerepresentatives of this city to -enter the 'above-. mentioned property for Inspection purposes. Signature of applicant _ Date Mailing Address City, State, Zip REMARKS ZONE: BY: Minimum Setback Distances: Front Setback from Center Rear Setback from Rear Side Street Setback f Side Setback from Tty FINAL DATE SPEC Issued by: Validated by: Validation: Li CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBINu FEES A.C. UNIT COLL. AREA SLAB GRADE 1ST FL. SO. FT. ® $ UNITS HEATING (ROUGH) STORAGE TANK FORMS Y } ARD SPKLR SYSTEM 2ND FL. SO. FT. p DUCT WORK ROCK STORAGE FOUND. REINF. MOBILEHOME SVC. BAR SINK i POR. SO. FT. ® OTHER APPJEOUIP. REINF. STEEL GAS (FINAL) POWER OUTLET ROOF DRAINS GAR. SO. FT. ® GROUT WATER HEATER SERVICE FINAL INSP. DRAINAGE PIPING CAR P. SO. FT. @ WATER SYSTEM WALL SO. FT. ® DRINKING FOUNTAIN FINAL INSP. URINAL SO. FT. ® ROOFING ESTIMATED CONSTRUCTION VALUATION $ 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 I GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED I 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 ® 11A c SEWAGE DISPOSAL FINAL INSPECTION SO.FT.GAR ® 3/ac HOUSE SEWER CERT. OCC. 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. 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 � / REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATION/SOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURES/INITIALS GARDEN WALL FINAL 4r� --/� � �� ' � t � � �? `� � � � � � 3 � R 9, � � � � �- � " �'� 0 � n r � � � � � � �l `. M °Q O, N ., � T � $ c 2 y �� 4r� --/� � �� ' � t � � �? `� � � � � � 3 � R 9, � � � � �- � " �'� 0 � n r � � � � � �