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15852 (RER)' C&4 • P.O. BOX 1504 No. 15852 Building 78-495 CALLE TAMPICO Address 48-519 Vias Baca:`t`,.o LA QUINTA, CALIFORNIA 92253 Owner Richard Mason Mailing BUILDING: TYPE CONST. OCC: GRP. Address 48--519 'iiia Encant© A.P. Number City Zip Tel. La $uinta 1 92263 Legal Description Contractor Project Description Install Glass Sled. window in Larry Gumtz Construction Faster bath 15320 - Patronella City Zip Tel.: Gardena 1.90249 310-679-7.13 State Lic. City & Classif.424049 Gen +*130 Lic. # 2789 Arch., Engr., Designer Address Tel. City. (Zip (State Lic. #- LICENSED CONTRACTOR'S DECLARATION ,(I heret.by affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Divisiop 3 of the Business and Professions Code, and my license is in full force and - ' $LGNATUf1E% It DATE w 'exempt 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 rile 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 rive 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. If, however, the budding or Improvement is sold within one year of completion, the owner -builder will have the burden of proving that he did not build or i iprove for the purpose of sale.) . ❑ 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) (rcensed pursuant to the Contractor's License Law.) ❑ 1 am exempt under Sec. B. & P.C. for this reason Date Owner WORKERS' COMPENSATION DECLARATION X. 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'COMPENSATIONINSURANCE (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 the work for which this permit is issued, I shall not employ any person in any manner;so as to become subject to the Wk' Compensation Laws of California Workers' Date-Owner--Ir-'r NOTICE TO APPLICANT. ' ff, after : makfng this ,Cert- icate 11o'f Exemption your s gg td become subject to the Workers' Compensatlon provis(o� of the labor Code, you rr�Lst -forthwith with such provisions or this perms 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 ($100,000), 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 it 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 ZONE: .32" X 400 Minimum Setback Distances: Sq. Ft. Size No. Stories No. Dw. Units New ❑ Add Alter ❑ Repair ❑ Demolition ❑ Side Street Setback from C r Line Side Setback from Pr ine IN FINAL DATE -ETORs Issued by: Date Estimated Valuation. $400.00 Validated by: PERMIT AMOUNT Plan Chk. Dep. . Validation-. Plan Chk. Bal. Const. 30.00 Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure TOTAL 30.00 REMARKS ZONE: BY: Minimum Setback Distances: Front Setback from Center Line Rear Setback from Rear Prop I e / Side Street Setback from C r Line Side Setback from Pr ine IN FINAL DATE -ETORs Issued by: Date Validated by: Validation-. CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBINU FEES 1ST FL. SO. FT. ® $ UNITS COLL. AREA 2ND FL. SO. FT. p YARD SPKLR SYSTEM POR. SO. FT. ® MOBILEHOME SVC. BAR SINK GAR. SQ. FT. ® POWER OUTLET ROOF DRAINS CAR P. SQ. FT. DUCT WORK DRAINAGE PIPING WALL SQ. FT. DRINKING FOUNTAIN SO. FT. ® HEATING (FINAL) URINAL ESTIMATED CONSTRUCTION VALUATION $ WATER PIPING NOTE: Not to be used as property tax valuation FLOOR DRAIN MECHANICAL FEES WATER SOFTENER VENT SYSTEM FAN EVAP.000L HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER 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, TEM/PERM LAVATORY HEATING SYSTEM FORCED GRAVITY AMPERES SERV ENT SHOWER BOILER B.T.U. SO. FT. ® c BATH TUB SQ. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SQ. FT. RESID ® 11/4 c SEWAGE DISPOSAL FIREPLACE SQ.FT.GAR Q 3/ac HOUSE SEWER SPARK ARRESTOR GAS PIPING PERMIT FEE GAR. FIREWALL 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 REMARKS: VENTILATION FIRE ZONE ROOFING , FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATION/SOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURES/INITIALS GARDEN WALL FINAL