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10131 (BLCK)Building Address P.O. BOX 1504 N Q . 78-105 CALLE ESTADO � —�� Goldenrod Circle LA QUINTA, CALIFORNIA 92253 Ribbert Whipple Mailing Address same City Zip Tel. � u Quinti 0-2253 ' Contractor Cerner/Builder Address Zip State Lic.I City & Classif. Lic. # Arch., Engr., I Designer Address Tel. CityI Zip I State I 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 I hereby affirm that 1 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 or 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 pemu7 subjects the applicant to a civil penalty of not more than five hundred dollars ($500). 61, 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 doessuchwork 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.) b 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.) O 1 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.) 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 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. u ! + Date Owner r �' " F + .> NOTICE TO APPLICANT: It, after making this Certificate of Eiemption,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, State, Zip BUILDING: TYPE CONST. OCC. GRP. Number Legal Description Project Description 83' of 6° block wall Sq. Ft. Size, No. Stories No. Dw. Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation r d� PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. Const. • U tJ Mech. . Electrical Plumbing S.M.I. i U Grading Driveway Enc. Infrastructure TOTAL 54-30 REMARKS i141,.SJ i €Iz t�S�ti. I:iw51S 7 �Q �, '�`�w� LrY1� f7 ..) y �„t t i;ti•. .t ✓-r . v4y 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 IST FL. SQ. FT. a $ UNITS SLAB GRADE ROUGH PLUMB. YARD SPKLR SYSTEM 2ND FL. SQ. FT. STORAGE TANK FORMS . f117 SEWER OR SEPTIC TANK MOBILEHOME SVC. BAR SINK POR. SQ. FT. ® FOUND. REINF. GAS (ROUGH) GAR. SQ. FT. ® POWER OUTLET ROOF DRAINS REINF. STEEL GAS (FINAL) DRAINAGE PIPING CAR P. SD. FT. GROUT WALL SQ. FT. SERVICE DRINKING FOUNTAIN, SQ FT ® BOND BEAM /e �! t URINAL ESTIMATED CONSTRUCTION VALUATION $ GRADING cu. yd. $ -Plus-x$-=$ WATER PIPING NOTE: Not to be used as property tax valuation FLOOR DRAIN MECHANICAL FEES FINAL INSP. WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER REMARKS: GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED LAUNDRYTRAY 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. SQ. FT. RESID ® 11/4 c SEWAGE DISPOSAL MESH SQ.FT.GAR ® 3/+c HOUSE SEWER INSULATION/SOUND GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEE MECH.FEE PL.CK.FEE CONST. FEE ELECT. FEE SMI FEE PLUtFEE STRUCTURE ,n / 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 . f117 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 /e �! t 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 G FINAL INSPECTION- NSPECTION CERT. CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESJINITIALS GARDEN WALL FINAL