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9601-176 (RPL)LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect. j "�y��>tti� B j j pk"r License # Lic. Class Exp Date Date 4, Signatureof Contractor OWNER -BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractor's License Law for the following reason: ( ) 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, Business & Professionals Code). ( ) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business & Professionals Code). ( ) I am exempt under Section , B&P.C. for this reason Date Signature of Owner WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: ( ) I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ( ) I. have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation insurance carrier & policy no. are: Carrier Policy No. VW114 (This section need not be completed if the permit valuation is for $100.00 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 workers' compensation laws of California, and agree that if I should become rubject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with -Rose pfovisionsa"� Date: n �� • 0 ApplicantF r ✓'. Warning: Failure to secure Workers' Compensation coverage isawful and shall subject an employer to criminal penalties and civil fines up to $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. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on his application. 1. Each person upon whose behalf this application is made & each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this application agrees to, & shall, indemnify & hold harmless the City of Indian Wells, its officers, agents and employees. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is correct. I agree to comply with all City, and State laws relating to the building construction, and hereby authorize representatives of this City to enter upon the above-mentioned property for inspection purposes. Signature (Owner/Agent) "`C" BUILDING PERMIT PERMIT,\r,�,� F DATE VALUATION S) LOT TRACT JOB SITE ADDRESS -57-575 VLX:' E0iD0AM'bl APN OWNER CONTRACTOR %A^a;1,,�I; 9-: ;�:'L°w'{� ��`.� 't';"�`1' �(��r�1'll t"�;��"�'1�: PD1 1�.�/. i f 1 ixe PALM SF��1NE;S e A 11226 PAIA4 SPI:.lNOS C !1!2h it►t!`)i }4-;)a v'd (Tilfel ffY11)1��' 17:r DESIGNERIENGINEER USE OFPERMIT4,9,'1;,.�F113+`i_h =1y` P(X 11, ANI) wYA FEE DESCRIPTION FEES ('0N t IZA/ `f ANIA3YJAr"d" i4gi i gfat3f3 .S FISI'I:�W AI k ID C UTT OF {iCsN NI'saElMICIN t1fQd M°1' F'VV S1i1#MAR PiliIAN�(101ro;CKI.Vi, 101-000- 9-,311 fI NS`1`J LXX 1011.11 . 101-MM-118-o�� $141;.`M XAFCHA141C AL Fr. ' -- POOL 101-000-1121-0(10 SII=I (Ati I . FC4`f.'RWAj, Fhl-* -- PiA J. 101-000420-009 S4+'4 JA$ PLO NIR1NO F+FF -- POOL 101.000-419'-M `5w`'-t36i 1_�� Tri' Al. 5,5.}M` IT iilTt�i�i�f � A1'41) A"LAli CHECK slip LESS PRIE-HAIL IT S 4) ¢: E RECEIPT DATE BY DATE FINALED INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings Ducts Slab Grade Return Air Steel Combustion Air Roof Deck Exhaust Fans O.K. to Wrap F.A.U. Framing Compressor Insulation Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wail Firewall Exterior Lath Drywall - Int. Lath Final Final POOLS - SPAS BLOCKWALL APPROVALS Steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Under Plbg. Test Final Gas Pipin PLUMBING APPROVALS as est Electric Final Waste Lines Heater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K for Finish Plaster Sewer Lateral Pool Cover Sewer Connection Encapsulation 7 Gas Piping Gas Test Appliances Final / COMMENTS: Final Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole Underground Conduit Rough Wiring Low Voltage Wiring Fixtures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) . . It7^ q1S VIM�5 ff DoT 6ll M P.O: BOX 1504 APPLICATION ONLY tAye �, • - Building 78-105 CALLE ESTADO Addresd' LA QUINTA, CALIFORNIA 92253 Mailing /y At ress. 0 / �� c:iy' E6r�tractors Address 117) Zlp/ State Lic. U7 V City &Classif. C� �j Lic. # Arch., Engr Designer . Address(j>b / /i�v ,Tel. > a Y (pig 7 / 1 / City ZipState l G '7>->6!7'' Lic. # 2 -I f U LICENSED CONTRACTOR'S DECLARATION I Hereby affirm tpa 1'amlicensed under provisions of Chapter 9 (cominen Ing with Section 7000) of DMsion of<t�t}ee� Its) ss and Professions Code, and myplicense i in fyll force and effect. '/ Y/Y 4 _ 1 //! 7 , /J OWNER -BUILDER DECLARATION I hereby affirm that 19.m 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). 17 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 or 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.) I'1 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 contractors) licensed pursuant to the Contractor's License Law.) 17 1 am exempt under Sec. B. 8 P.C. for this reason Date Owner WORKERS' COMPENSATION DECLARATION 1 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. O 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 ($100) valuation or less.) I certify that in the performance of thg work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date Owner NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code.) Lender's Name Lender's Address This is a building permit when properly filled out, signed and validated, and is subject to expiration if work thereunder is suspended for 180 days. I certify that I have read this application and state that the above information is correct. Iagree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives sof this city to enter the above- mentioned property for inspection purposes. Signature of applicant Date Mailing Address City, State, Zip BUILDING DIVISION BUILDING: TYPE CONST: OCC. GRP. A.P. Number Legal Description Project Description ZONE: BY: Minimum Setback Distances: Front Setback from Center Line Rear Setback from Rear Prop..Line Side Street S6155ck-from—CenterLines Side Setback fro P'o{ , e.rt Line FINAL DATE 9I rJSPECTOR II I Issued by: Dat NAY 4 P rmj �5 II N Validated by: I Rt�7 01 Validation: r `~------� Sq. Ft. lJ Size No. Stories No. Dw. Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation ►� 1671 4 '2266 . 00 PERMIT AMOUNT Plan Chk. Dep. T%1,97(0- C) C) Plan Chk. Bal. O 5 Const. 577 5-0 Mech. D • D Electrical .03 Plumbing S.M.I.1/0-14 Grading 10-00 Driveway Enc. —.0— .0— Infrastructure Infrastructure3 Zj$. C 3i G TOTAL REMARKS ZONE: BY: Minimum Setback Distances: Front Setback from Center Line Rear Setback from Rear Prop..Line Side Street S6155ck-from—CenterLines Side Setback fro P'o{ , e.rt Line FINAL DATE 9I rJSPECTOR II I Issued by: Dat NAY 4 P rmj �5 II N Validated by: I Rt�7 01 Validation: r `~------� CONSTRUCTION ESTIMATE ol NO. ELECTRICAL FEES NO. PLUMBING FEES COLL. AREA 1ST FL. SO. FT. fg $ 2ND FL. SO.FT.@-`�+9�-3 POR. S0. FT. @ ' GAR. S0. FT. CAR P. SO. FT. @ WALL SO. FT. @ SO. FT. @ ESTIMATED CONSTRUCTION VALUATION $ 1 � 1 Z l 8 UNITS MOBILEHOME SVC. POWER OUTLET HEATING (ROUGH) YARD SPKLR SYSTEM BAR SINK ROOF DRAINS DRAINAGE PIPING DRINKING FOUNTAIN URINAL WATER PIPING FORMS SEWER OR SEPTIC TANK NOTE: Not to be used as property tax valuation DUCT WORK ROCK STORAGE FOUND. REINF. FLOOR DRAIN METER LOOP HEATING (FINAL) It MECHANICAL FEES REINF. STEEL GAS (FINAL) TEMP. POLE WATER SOFTENER GROUT VENT SYSTEM FAN EVAP.000L HOOD SERVICE SIGN WASHER(AUTO)(DISH) WATER SYSTEM APPLIANCE DRYER =$ LUMBER GR. GARBAGE DISPOSAL FRAMING FINAL INSP. FURNACE UNIT WALL FLOOR SUSPENDED / LAUNDRY TRAY REMARKS: AIR HANDLING UNIT CFM KITCHEN SINK FIRE ZONE ROOFING ABSORPTION SYSTEM. B.T.U. FIREPLACE TEMP USE PERMIT SVC WATER CLOSET COMPRESSOR HP POLE, TEMIPERM LAVATORY LATHING HEATING SYSTEM FORCED GRAVITY MESH AMPERES SERV ENT SHOWER INSULATIONISOUND BOILER B.T.U. SO. FT. @ c BATH TUB fn FINAL INSPECTION S0. FT. @ c CERT. OCC. WATER HEATER FENCE FINAL MAX. HEATER OUTPUT, B.T.U. S0. FT. RESID @ 1+/. c SEWAGE DISPOSAL r GARDEN WALL FINAL SO.FT.GAR @ 3/ac HOUSE SEWER GAS PIPING PERMIT FEE =T PERMIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEE CH (Oq"? PL.0 E ��.� CONST. FEE 977. ELECT. FEE 76 °3 SMI FEE PL 6 B. FEE 50 STRUCTURE PLUMBING ELECTRICAL HEATING R 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 APP./ECUIP. 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 r GARDEN WALL FINAL