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12949 (RPL)A' • P.O. BOX 1504 N o . Building78. 75.5 Grand Traverse 78 105 CALLE Address LA QUINTA, CALIFOORNIARNIA 92253 Owner COt Unity Bank BUILDING: TYPE CONST. OCC. GRP. Mailing Address 100 East Corson Street A.P. Number City lZip ITel. Contractor Aaaress 58-465 Perez. Road CityZip Tela Cathedral wit r, CA 92234 32$-'-2581 State Cla sC-S3 29573v if. 6 Llcy &# 59 Arch., Engr., - Designer Address Tel. City Zip State Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am' m licensed undevprovisfons of Chapter 9 (commencing with Section 7000) of Division'* of th eBusiness and`,Prdfes .ions'Code,.and my license is in full forceand SIGNATURE DATE OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason: (Sec. 7031.5,Susiness 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 Me 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 or not more than five hundred dollars ($500). (3 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 or proving that he did not build or improve for the purpose of sale.) 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) licensed pursuant to the Contractor's License Law.) ❑ 1 am exempt under Sec. B. & P.C. for this reason ! Date Owner I WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self -insure, or a certificate of Worker's CorIlpehsation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.) Policy No Company D -dopy 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. 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 Ihereby 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 Description t Description Pool and Sna 12949 ZONE: BY: Minimum Setback Distances: Sq. Ft. Size No. No. Dw. Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Side Street Setback from Center Line Side Setback from Pr- pe4ly Line 1� FINAL DATE INSOR17 Issued by: i Date .�. w Estimated Valuation t' • "� �' �' • PERMIT AMOUNT Plan Chk. Dep. ,. Plan Chk. Bal. . A Const. �. n Mech.— Electrical ,�,, Plumbing S.M.I. Grading Driveway Enc. Infrastructure A TOTAL 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 Pr- pe4ly Line 1� FINAL DATE INSOR17 Issued by: i Date Validated by: �1Ppermi ryrT Validation: By N. i1 CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL SO. FT. ® $ UNITS A.C. UNIT COLL. AREA YARD SPKLR SYS-r.M 2ND FL. SO. FT. @ ROUGH PLUMB. BONDING MOBILEHOME SVC. BAR SINK FOR. SO. FT. ® FORMS SEWER OR SEPTIC TANK POWER OUTLET ROOF DRAINS GAR. SO. FT. ® DUCT WORK ROCK STORAGE FOUND. REINF. DRAINAGE PIPING CAR P. SQ. FT. ® WALL SO. FT. OTHER APP./EQUIP. DRINKING FOUNTAIN GAS (FINAL) URINAL SQ. FT. ® ESTIMATED CONSTRUCTION VALUATION $ ' - - - WATER PIPING NOTE: Not to be used as property tax valuation SERVICE FLOOR DRAIN MECHANICAL FEES FINAL INSP. WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASH ER(AUTO)(DISH) APPLIANCE DRYER 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, TEMIPERM LAVATORY HEATING SYSTEM FORCED GRAVITY AMPERES SERV ENT SHOWER BOILER B.T.U. SQ. FT. ®c BATH TUB VENTILATION SQ. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SQ. FT. RESID ® 11/4 c SEWAGE DISPOSAL FIREPLACE SQ.FT.GAR ® 3/ac HOUSE SEWER 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 METER LOOP HEATING (FINAL) OTHER APP./EQUIP. 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 INSULATION/SOUND FINISH GRADING FINAL INSPECTION -1,?- G CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL "DING& SAFETY 'A m R' O { S. r 3 {: L CONMUM014 "o'', o . � :1{ q! { N A: P�' ' 0 49WHEDRAL CITY CA 52235-0399 od PHONE 328-2681 M'MM A I AF'!'L'rCr;ri .. H-5 r LATE (RV a0 � 4 • 1110;4A f F_ 41. 4� ♦o s = — - SII Q POOL AREA_TO BE ENCLOSE® BY I 5� MINIMUM 5 FT. HIGH FENCE. t o_ —LOSING 1'-011 L.LNDSELF—LATCHING.