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10877 (RPL)4'4ui`crc A. P.O. BOX 1504 No. 10877 Building. 50-175 ©��� 7&105 CALLE ESTADO Address LA QUINTA, CALIFORNIA 92253 Owner OSAMA SHOEAIR Mailing Address SAME City Zip Tel. LA QUINTA 1 92253 1345- Contractor ^P 0J BOX 3503 City Zip Tel.: PALM DESERT 92260 360-1362 State Lic. City & Classif. 359001 Lic. # 1902 Arch., Engr., Designer Address, Tel. City I Zip I 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 and7Professions Code, and my license is in fulkforce and /effect AL ( _ -4;1 SIGNATURE 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 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 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, euisness 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 or sale.) - ❑ 1, as owner of the property, am exclusively contracting with licensed contractors to'con- strucl 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.) - 0- 1 am exempt under Sec. B. & P.CG 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 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 pperson in any manner iso as to/become subject to the Workers' Compensation, Lawsf,Callfornia. j✓-Eri L la° e:r�!'' f '•` •�.. r„}v Date /' J!J ' Owner ' rte•• NOTICE TO APPLICANT: If, 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 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 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 Dale• Mailing Address City, State, Zip BUILDING: TYPE CONST. OCC: GRP. A.P. Number Legal Description D.,,ie f n .... inlir 22*0 WIRING TO SPA _tri. LO, i11 1 IV 1 til, i x. a a.1xur TOTAL $15.00 REMARKS ZONE: BY: Minimum Setback Distances: Front Setback.from Center Line Rear Setback from Rear Prop. Line Sq. Ft. Size No. Stories • No. Dw. Units New ❑ Add ❑ Alter ❑. Repair ❑ Demolition ❑ Date Permit Validated by: Validation: Estimated Valuation $800 PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. Const. Mech. Electrical $15.00 Plumbing S.M.I. 1 Grading Driveway Enc. Infrastructure _tri. LO, i11 1 IV 1 til, i x. a a.1xur TOTAL $15.00 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 Issued by: ' Date Permit Validated by: Validation: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SQ. FT. ® $ UNITS COLL. AREA 2ND FL. SQ. FT. ROUGH PLUMB. YARD SPKLR SYSTEM MOBILEHOME SVC. BAR SINK POR. SQ. FT. ® SEWER OR SEPTIC TANK ROUGH WIRING. GAR. SQ. FT. ® POWER OUTLET ROOF DRAINS CAR P. SQ• FT. @ GAS (ROUGH) DRAINAGE PIPING WALL SQ. FT. HEATING (FINAL) DRINKING FOUNTAIN. SQ FT ® GAS (FINAL) URINAL ESTIMATED CONSTRUCTION VALUATION $ WATER PIPING NOTE: Not to be used as property tax valuation WATER HEATER FLOOR DRAIN MECHANICAL FEES FINAL INSP. WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER GRADING cu. yd. $ plus x$ GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED LAUNDRY TRAY AIR HANDLING UNIT CFM FINAL INSP. KITCHEN SINK ABSORPTION SYSTEM B.T.U. TEMP USE PERMIT SVC WATER CLOSET COMPRESSOR HP POLE, TEWPERM 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 ® 1 V. c SEWAGE DISPOSAL SQ.FT.GAR ® V4c HOUSE SEWER GAR. FIREWALL GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEE MECH.FEE PLCK.FEE CONST. FEE ELECT. FEE SMI FEE PLUMB. FEE STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR SETBACK GROUND PLUMBING NDERGROUND - '"� 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 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 INSULATIONISOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESlINfT1ALS GARDEN WALL FINAL