15248 (BLCK)4
�jL./JZ�`� I�3i��5 �•
y 1 970 & 4--791V L& N1C,^
�1-81. 5,845,935,995 P.O. BOX 1504 N0.15248
Buil n r' i c� 78-495 CALLE TAMPICO /
Address^�' ``' �i Via Fi l':::,Z LA QUINTA, CALIFORNIA 92253 L�
Owner / (1ji• I%C `
Centuryt(t�:f::� Ct:;u1mt1.37i�tis��
Mmilinn BUILDING: TYPE CONST. OCC. GRP,
Address 1535 South "DR�2.f,�::
City
Sora P ,°,i:nardi
Contractor
S &IfI(--•
ty
P. Number
Zip Tel. ,
CA 92408 (909)381-6007 Legal Description szaCL 26153
Project Description 750 1. f . - Of 6' high garden
State Lic.
& Classif. R 314473
Tela
Lic. # 212 0
Designer
•
Designer nk raGonzales & Associate
9ITV Faso Chapman Ave. ITel'714)532-,,7,
City a )Zip. )State .
0> tinge, _C; -,k, 5:.666 Lic.#
1 LICENSED CONTRACTOR'S DECLARATION
hereby efflrm that I am licensed under provisions of Chapter.8 (commencing with Section
i . ) o} Division Sof the Bu9lness and Professions Codg,enff my license is in full force and
feet _ _ �: --------
SLGNATIJRE ' DATE
OWNER•BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractors License Law for the following
reason: (Sec. 7031.5,Buskiess 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 Penn# to files 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
isubjects the applicant to a civil penalty of not more than five hundred dollars ($500).
01, as owner of the property, or my employees with wages as their sole compensation, will
1 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 mproves thereon and who does such work himself or through his own employees,
i provided that such improvements - are not' intended or offered for sale. d, however, the building
or improvement Is sold within one year of completion, the owner-bulider will have. the burden
of proving that he did not build or inprove for the purpose of sale.)
O I, as owner o�fh.eo�perty, am exclusively contracting with licensed contractors to con-
struct the proje7044, Business and.Professions Code: The Contractor's License Law
does not apply towner of property who builds or improves thereon, and who contracts for
such projects with a contrector(s) Pcensed pursuant to the Contractor's License Law.)
❑ 1 am a Under Sec B. & P.C. for this reason
1
Date Owner
WORKERS' COMPENSATION DECLARATION
t hereby affirm that 1 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' COMPENSATION INSURANCE
(This section need not be completed ff the permit Is for one hundred dollars (S100) valuation
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' Compensation
Laws of California.
Date Owner
NOTICE TO APPLICANT: N, 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 ($100,0)0), 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 if work thereunder is suspended for 180 days.
I certify that I have read this application and stale 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-
Me ' ilin
ateMailing Address
City, State, 'Zip
privacy wall
Sq. Ft. No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
198.00
Mech.
Electrical
Plumbing
FINAL DATE
S. M.I.
Grading
Issued by:
Driveway Enc.
Infrastructure
Validated by:
Validation:
\ ;
TOTAL
REMARKS
ZONE:
BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
J
Side Setback from Property Line
FINAL DATE
•INSPECTOR 1
Issued by:
Date Permit
Validated by:
Validation:
\ ;
. s