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11196 (RER)P.O. BOX 1504 Building^��.�� 78-105 CALLE ESTADO Address LA QUINTA, CALIFORNIA 92253 Dale Stone Address same. City Zip Tel. .La Quanta 92253 Contractor owner/Builder Address Zip Tel.: State Lic. (City & Classif. Lic. # tArcn., tngr., . . Designer Address Tel City Zip State Lic. # LICENSED CONTRACTOR'S DECLARATION ' I hereby affirm that I am licensed under Provisions of Chapter 9 (commencing with Section 7000) t. of Division 3 of the Business and Professions Code, and'my . license is in full force and effec. _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, atter, 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) o1 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.($500). • . . . "I, as owner of the property, or my employees with wages as their sole compensation, will o the work, and the structure is not intended or offered -for sale. (Sec. 7044, Buisness and Professions Code: The Contractor's License. Law does not apply to an owner of property who - builds or Improves thereon and who does such work himself. or through his own employees, provided that such improvements are not. intended or offered for sale.. If, however., the building. or.improvement is sold within one year of completion, the owner -builder will have the burden of proving that he did not build or Improve for the purpose.of sale.) ., ❑ I, asowner of the property, am exclusively contracting with licensed contractors to con• struct the project. (Sec. 7044, Business and Professions Code: The. Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) ❑ I am exempt under Sec. �^ B. & P.C: for this reason Date # S • A' Own r i WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a'certificate of consent to self -insure, or a certificate of WorkeRs Compensation insurance, or a certified copy thereof: (Sec. 3800, Labor Code.) Policy No. .Company . .❑ Copy Is filed with the city. ❑ Certified copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION. INSURANCE (This section need not be completed if the permit is for one hundred dollars ($too) valuation or less.) I certify that in the performance of the work for which this permit is issued, I shall not employ -any arson in any mariner so as to become subject to the Workers' Compensation Laws of California. r F j , Date i', 11 t ¢ �• Ownere; " / r t �7` l,-: _ r .4- f r r 1 J sYti c NOTICE TO APPLICANT 11 aper makingthis'Certificate of Exemption yd' I should become 'subject to the Workers O•ompensahon provisions of the`l 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 No. 11196 BUILDING: TYPE CONST. OCC: GRP. A.P. Number. Legal Description Project Description Glass. Block Window 32".8 40,99 Sq. Ft. Size No. No. Dw. Stories - Units New ❑ Add ❑ Alter ❑ Repair ❑ - Demolition ❑ Estimated Valuation 37$,00 PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. Const. 15-00 Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure i -� 1J ';atif" e Y 1,! -412'1 J _T cK d .R 1 i i/ "1 TOTAL 15.00 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 Property. Line FINAL DATE INSPECTOR Issued by: Date Permit Validated by: Validation: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SQ. FT. ® $ 2ND FL. SQ. FT. POR. SQ. FT. ® GAR. SO. FT. ® CARP. SQ. FT. WALL SQ. FT. ® SQ FT ® ESTIMATED CONSTRUCTION VALUATION $ UNITS MOBILEHOME SVC. POWER OUTLET YARD SPKLR SYSTEM BAR SINK " ROOF DRAINS ` DRAINAGE PIPING DRINKING FOUNTAIN. URINAL WATER PIPING NOTE: Not to be used as property tax valuation BONDING FLOOR DRAIN MECHANICAL FEES FORMS WATER SOFTENER VENT SYSTEM FAN EVAP.000L HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER GAS (ROUGH) GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED OTHER APPJEOUIP. LAUNDRYTRAY AIR HANDLING UNIT CFM TEMP. POLE 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 SQ. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 11/4 c SEWAGE DISPOSAL i SQ.FT.GAR ® 3/ic HOUSE SEWER REMARKS: GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEEMECH.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 ou. yd. $ plus X$ _$ LUMBER GR. FINAL INSP. RAMING �Y FINAL INSP. ROOFING i i REMARKS: VENTILATION FIRE ZONE ROOFING: FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATIONISOUND FINISH GRADING 4K!fAL INSPECTION S/ CERT. OCC. FENCE FINAL - INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL