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14354 (CSCS)i Ir � P.O. BOX 1504 No. 14354 Building '' r,.g ga hind os tf:a LA OUINTA, CALIFORNIA8-495 CALLE 9 Address 2253 '" Owner Richard Cracket VIN Mailing BUILDING: TYPE CONST. OCC: GRP. �2 Address Same A.P. Number ci y Zip Tel. La. Ninta. Villa a �- Sh© 1. ¢UlYlta: 922�3 564-0684 Legal Description g � Contractor: `i':• OLISEXUCt1O113 Project Description. idress P.O. labx 1012 a Quirsta CA Z'p 92253 8�`Ciassif b. 397830 Tic'# 1375 Arch., Engr., - Designer Address Tel. City Zip State Lic. # —NSED CONTRACTOR'S DECLARATION. I hereby affirmAthat I am -iLe Zad under provi ieWs`of Chapter 9 (commencing with Section - of Division 3 oil Bogginess and,Pr9fessions Csgde,.and_mydieenseMSin full force and. yY/ OWNER -BUILDER DECLARATION I 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, after, improve„ demolish, or repair. any structure, prior to its .issuance also requires the applicant for such permit to file a signs :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 penaffy 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 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) licensed 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 ffirrm that I have a certificate of consent to self -insure, or, a.certificate'of Worker's pensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.) Poli "y o• Company Copy is filed with the city, ❑.Certified copy Is hereby furnished.. Sq. Ft.. ; No. Size Stories New ❑ Add ❑ Alter ❑ stimated Valuation" r"Clfj1(j. PERMIT Plan Chk. Dep. Plan Chk." Bal'. Const: Electrical' Plumbing • S.M.I.- No. Dw. Units Repair ❑ Demolition p , AMOUNT H1 • UU • Ei Driveway Enc. Infrastructure TOTAL '4 • CERTIFICATE OF EXEMPTION FROM REMARKS 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 the work forwhich 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: N, after making this Certificate- of -Exemption you should become ZONE: BY: subjeci to the Workers' Compensation provisions of.the Labor code, you must forthwith MIfIIn1Um`Setback Distances:. . comply with such provisions or this permit shall be deemed revoked. Front Setback from Center Line Rear Setback from Rear Prop. Line WARNING: FAILURE TO SECURE WORKERS'COMPENSATIONCOVERAGEISUNLAWFUL. AND Side Street Setback from Center Line 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, � y' Side Setback from Pf/Oe 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 :.. FINAL DATE INS OR expiration it work thereunder is suspended for 180 days. •: .. . I certify, that.• have read this application and state that the. above information is correct. Issued by.Date Perini 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 bove mentioned property for inspection purposes. Validated by: Signature of applicant Date f /, Mailing Address Validation: City, State, Zip CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBINU FEES 1ST FL. SO. FT. ® $ 2ND FL. SO. FT. ® POR. SO. FT. ® GAR. SO. FT. ® CAR P. I SO. FT. WALL SO. FT. SO. FT. ® ESTIMATED CONSTRUCTION VALUATION $ UNITS MOBILEHOME SVC. POWER OUTLET ' YARD SPKLR SYSTEMJ BAR SINK ROOF DRAINS DRAINAGE PIPING DRINKING FOUNTAIN, URINAL WATER PIPING NOTE: Not to be used as property tax valuation ROUGH PLUMB. FLOOR DRAIN MECHANICAL FEES HEATING (ROUGH) WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASH ER(AUTO)(DISH) APPLIANCE DRYER DUCT WORK GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR . SUSPENDED GAS (ROUGH)/0 , C L LAUNDRY TRAY AIR HANDLING UNIT CFM HEATING (FINAL) 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 BOND BEAM SO. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 1 Va c SEWAGE DISPOSAL LUMBER GR. SO.FT.GAR ® 3/ac HOUSE SEWER FINAL INSP. ROOFING GAS PIPING PERMIT FEE MIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEE MECH.FEE FPL.CK.FEE CONST. FEE ELECT. FEE SMI FEE PLUMB. FEE STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR SETBACK ROUND PLUMBING///-, C�� UNDERGROUND A.C. UNIT COLL. AREA ' SLAB GRADE ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMS SEWER OR SEPTIC TANK, BOUGH WIRING1GL/-7CK 6 DUCT WORK ROCK STORAGE FOUND. REINF. GAS (ROUGH)/0 , C L 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. NAL 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 SIGNATURESIINITIALS GARDEN WALL FINAL