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9682 (AR)P.O. BOX 1504 No. Building 78-105 CALLE ESTADO Address 48221 Calle Floristas LA QUINTA, CALIFORNIA 92253 -d Owner ( UY Thomas Bussiaeger IBUILDING: TYPE CONST. _OCC. GRP.. Address sarne . City Zin Tel. La Quinta 1'92253 1 1 Contractor Owner/Builder Address Zip I Tel.: State Lic. City & Classif. I Lic. # Arch., Engr., Designer Address —T—Te-1. City Zip State I I Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7 of Division 3 of the Business and Professions Code, and my license is in full force and t. 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,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 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 a n ,!�bjects the applica t to a civil penalty of not more than rive hundred dollars ($500). E111, 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.) 0 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 contractor(s) licensed pursuant to the Coninictor's License Law.) 0 1 am exem'pt under sec. 'Ofr_� _13. &,-P,,C. or this reason Date //4'41/n-viner \1 41�-��l AZ -- Ji L/ 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.) Pol'Soo..Company Copy is filed with the city. 0 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 thq work for which this permit is issued, I shall not =any erreon in any manner so as to become subject to the Workers' Compensation Cali Fo n a. Date_Owner NOTICE TO APPLICANT., If, after making this Certificate of Exemption you should beco . me 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. 309 7, Civil Code.) Lender's Nam Lender's Address This is a building permit when properly filled out, signed and validated, and is subject to expiration it work thereunder is suspended for 180 days. I cer tity 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 Addres City, State, Zip P. Number Description Lot 11 Phase 2 Description Add overhanci REMARKS ^nC44's 4A 'IA -71k I () i0-1;kSFf i IUFj;4L I bt.ov ZONE: BY: Minimum Setback Distances: —Front Setback from Center Lin 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: Sq. Ft. Size 400 No. No. Dw. Stories Units New 0 Add 0 Alter 0 Repair 0 -Demolition 0 Estimated Valuation 5,240 PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. Const. Mech. Electrical Plumbing S.M.I. .60 Grading Driveway Enc. Infrastructure TOTAL 81.60 REMARKS ^nC44's 4A 'IA -71k I () i0-1;kSFf i IUFj;4L I bt.ov ZONE: BY: Minimum Setback Distances: —Front Setback from Center Lin 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 1ST FL. SO. FT. @ $ UNITS COLL. AREA 2ND FL. SO. FT. @ ROUGH PLUMB. YARD SPKLR SYSTEM I POR. SQ. Fr. @ - MOBILEHOME SVC. BAR SINK GAR. SQ. Fr. @ POWER OUTLET ROOF DRAINS CAR P. Q. Fr. @ DUCT WORK DRAINAGE PIPING WALL SO. Fr. @ GAS (ROUGH) DRINKING FOUNTAIN. SQ. FT. @ HEATING (FINAL) URINAL ESTIMATED CONSTRUCTION VALUATION $ GAS (FINAL) WATER PIPING NOTE: Not to be used as property tax valuation I FLOOR DRAIN MECHANICAL FEES WATER HEATER WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASH ER(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 @ I V4 c SEWAGE DISPOSAL SQ.FT.GAF1 @ 3/4c HOUSE SEWER GAS PIPING PERMIT FEE PERM FEE PERMIT FEE DBIL TOTAL FEES MICRO FEE MECH.FEE PL.CK.FEE CONST. FEE ELECT.FEE SMIFEE 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 ROCKSTORAGE FOUND. REINF. GAS (ROUGH) METER L60P 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 REMARKS. VENTILATION FIRE ZONE ROOFING: FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATIONISOUND FINISH GRADING FINAL INSPECTION - CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL