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14362 (BLCK)TAi!t P.O. BOX 1504 No. 14362 Building j�--320 Ave. Villa 78-495 CALLE TAMPICO Address LA QUINTA, CALIFORNIA 92253. Owner Raul. Velasco Mailing Same, Address. City Zip .. LaQuin to Z.Ch Contractor Address City Zip BUILDING:. TYPE CONST.' < LL OCC: GRP.,- A.P. Number Tel. 922:53 771-0167 Legal Description 7 pp ryy y . ,l. of X _highD10C. �.. Wal .. Project Description Tel.' ._. State Lic.. City & Classif...: ' Lic. # Sq. Ft. No. No. Dw. Size -- - Stories Units _ .. .. Arch.,_Engr., . , .. � Designer.• New ❑ Add ❑ , '- Alter ❑ : Repair ❑ Demolition,O 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) tof Division - � 3 of the Business and Pro fessions.Code,' and my license isiin•full force and ' effec. - . y .. .-,. .. .. SIGNATURE DATE OWNER -BUILDER DECLARATION. ' ' I hereby affirm that I am exempt from the Contractor's,License Law for.the following Estimated'Valuation + y��fj O)} • Treason:. (Sec.. 7031.5,Bustness. andProfessions Code:. Any city; or county + which requires: a' . permit to construct, atter, improve; demolish; or repair any structure, .prior to its ,issuance also • requires the applicant for such', Permit to file a signed statement that he is'licensed pursuant, to,,: the provisions of.the Contractor's,Ucense 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 - , PERMIT' ••. ' , ,AMOUNT .Plan thk; Dep. '. • - . . subjects the applicant to a civil penalty of not more"than five hundred dollars (8500). ' Q��ner 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 Coder The Contractor's. License Law .does not apply to an owner of property who Plan Chk. Bal. _ ..Const.' "T , - builds or improves, thereon and who does such work himself -or, through his own employees,'Mech..- provided that such improvements.are not intended.or offered for sale:_ If, however, Me.building Electrical - - 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.) Plumbing. - y O'1, 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 contractors) P.censed pursuant to the Contractor's'License.Law:) - - • ••_ O 1 am exempt under Sec.B. & P.C. for this reason n S,M.I.-- - -. - .. Grading' - ' Driveway Enc. Date r Owner ( "u' ''' Infrastructure WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a cerilficate of coriserit to 'self-insuirej 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. ❑Certifled copy. is hereby furnished. , TOTAL _ CERTIFICATE OF EXEMPTION, FROM WORKERS' COMPENSATION INSURANCE - REMARKS (This section need 'not be completed if the permit is for one hundred dollars ($ I GO) 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 Lows of California i_ }d, ate .: .,. ..Owner..i . fN ICE TO APPLICANT, If, after making this Certificate of Exemption you should become subject to the Workers' Compensation' provisions of tha Labor Code; you, meet forthwith comply with such provisions or this permit shall be deemed revoked. - lin zr:- r I I t ,. w QQQ 'ZONE:] BY:- 19✓ ' Minimurri-Setback Distances: ' - •. II Front Setback,frorrl (Mer Line Rear Setback from Rean-Top-1:'. _ _ 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, • Side .Street,Setba.Ck ffom Center Line : Side Setback feom;Property.•Line, 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. FINAL DATE - - INSPECTOR . . I certify that.l 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.. Issued by: yalldated-by: Date Permit - Signature of applicant Date . Mailing Address - Validation: City, State, Zip CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBIW%3 FEES 1ST FL. SO. FT. ® $ UNITS COLL. AREA 2ND FL.' SO. FT. p ROUGH PLUMB. YARD SPKLR SYSTEM POR. SO. FT. ® MOBILEHOME SVC. BAR SINK GAR. SO. FT. ® POWER OUTLET ROOF DRAINS CAR P. SO. FT. DUCT WORK DRAINAGE PIPING WALL '" SO. FT. GAS (ROUGH) DRINKING FOUNTAIN. SO. FT. ® HEATING (FINAL) URINAL ESTIMATED CONSTRUCTION VALUATION $ GAS (FINAL) WATER PIPING NOTE: Not to be used as property tax valuation FLOOR DRAIN MECHANICAL FEES WATER HEATER WATER SOFTENER VENT SYSTEM FAN EVAP.000L HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE " DRYER WATER SYSTEM GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED GRADING Cu. yd. $ plus x$ 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 SO. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 11/4 c SEWAGE DISPOSAL SO.FT.GAR ® 34c HOUSE SEWER SPARK ARRESTOR 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 %�J//�' /�/ G' • y %��� //i���; " • /� /�3/Q�j• /���A" l �/ LJ '(!� /�3�// � �/� `� ff + REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE - SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATIONISOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURES/INITIALS GARDEN WALL FINAL P.O. BOX 1504 Buildingy�[ 7&105 CALLE ESTADO Address 3 .� Lr1/ , LA QUINTA, CALIFORNIA 92253 Owner Mailing BUILDING: TYPE CONST. Address A.P. Number City I Zip ITel. Cont Address- Cjt Zip Tel. State Lic. City & Classif. Arcn., tngr., Designer Address Tel. CityI Zip I State I Lic. q LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of 09apter 9 (commencing with Section effect. of Divisio=thsines nd P ssions C e, and my license is in full force and effect. S GNAT DATE 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, alter, improve, demolish, or repair any structure, prior to its issuance also requires the applicant for such permit to file 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 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. It, however, the building orimprovement 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, 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.) I 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.) PqfisK No. Company Copy is filed with the city. fl Certified copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is lot 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. 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 Date Mailing Address City, Stale, Zip Legal Description APPLICATION ONLY OCC. GRP. Project Description Sq. Ft. No. No. Dw. Size Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. Const. Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure TOTAL REMARKS ZONE: BY: Minimum Setback Distances: Front SetbEck from Center Line Rear Setbai k from Rear Prop. Line Side Street Setback from Center Line Side Setback from Property Line FINAL DATE INSPECTOR Issued by: —Cate—Permit Validated by: Validation: m 304. 2-&1'6/VN C�--lq{ -1-73 CO