9603-014Building /t
Address 7 � Q, (111,/ A -
Owner ,.
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P.O. BOX 1504
78105 CALLE ESTADO
LA OUINTA, CALIFORNIA 92253
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Mailing
Address
City
Zip
Tel.
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Contractor
Address
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Zip
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Tel.
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State Lic.
& Classif. 1 Ur �ys
City
Lic. N
Arch., Engr.,
Designer Z/Z xS h
Address
Tel.
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Zip I
State
Lic. N
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisi ns o1 Chapter 9 (CO renting with Section
7000) of O' (stun 3 01 t e Bu ' es nd Profes ' s Code, a i se is' 1 I f ce and
effect
r
SIGNATURE DATE.
OWNER•13UILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractor's License Law for the following
reason: (Sec 7031.5.8
usiness and Professions Code: Any city or county wpich requires a
perms to construct. after. improve, demolish. of repair any structure, prior to is issuance arso
requires the applicant lot such permit to rile a &pried 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 oasis
for the aaeged exemption. Any violation of Section 7031.5 by any epicemt for a Permit
subjects the applicant to a civil penally of not more than five hundred dollars (11500). .
! ' 1, as owner of the property, or myemployees with wages as their sole Compensation, will
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Busness and
Professions Code:. The Contractor's License Law does not apply to an owner of property who
bnkls or improves thereon and who does such, work himself or through his own employees,
provided that such improvements are not intended of offered for sale. 11, however. me building
or improvement is sold within one year of completion, the owner-bueder will have the burden
of pro ring fhaI he did not build or improve lot the purpose of sale.)
I, as owner of the property, am exclusively contracting with licensed contractors to Coro
strut, the project. ISec. 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 conlractor(s) licensed pursuant to the Contractor's license Law.)
I am exempt under Sec. B. b P.C. for this reason
Date Owner
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. 3900. Labor Code.)
Policy No. Company
Copy is tiled with the city. : Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION. FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed it the permit is for one hundred doears (11100) valuation
or cess )
Ice it ify that in the performance of the work for which this permit is issued, 1 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, ff, after making this Certificate of Eaemplion you should become
subfect to the Workers' Compensation provisions of the Labor Code. you must forthwith
comply with such provisions Of this Permit shall be deemed revoked.
1 CONSTRUCTION LENDING AGENCY
t Ine,eby 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 it work thereunder is suspended for 180 days.
I cerlily that I have read this application and state that the above information is correct.
1 agtee to comply with all city and county ordinances and state laws totaling 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
I
APPLICATION ONLY
BUILDING: TYPE CONST.A/C` e-0OC�C. GRP.
A.P: Number A -I �Y y110
Legal Description_rm / 7 �2 /� a ��rr-q :7
Project Description Ci H ✓ �i
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:
Sq. Ft.
Size '17'-w:2, 'O' O
No. No. Dw.
Stories Units J
New,[ Add O
Alter O Repair O Demolition C
r
11
tf
_
Estimated V ata
PERMIT
AMOUNT
Plan Chk. Dep.'
\a,i
Plan Chk. Bal.
Const.
Mech:
Electrical
Plumbing
S:M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
DOD
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:
.
.
• . X606. oiy�
fit
^
FEE MOCK UP
-: ►�
PCa
SOU/UTE , .. UNIT
%
VAUJhTiOtJ:
fOOTnGE . • VALUAI ION VALUAT IOfJ
:I
14T FLOOR
2ND FLoon
--- --- --
GARAGE -� M t✓t:1{
--- -
COVEnw PORCI I
- -- '
TRELLIS
,
A/C
--- -
SPriiNKLEFi
-- _
TOTAL -
PEriMIT FEE-
EE
.-PLAN
-PLAN CI IECK FEE
M ECI IANICAL:
=
FANS
APPLIANCES: y
11EAT ERS :... .
TMS11 COMPACT ORS '
4
COMPRESSOtiS .
GARBAGE DISPOSAL
EVAP COOLERS
APPLIANCES
i
MNGE.
COOKIOP
REFnIGETUh OR
,ELEcTniCAL:
ICE MACI111lE
" DruNKING FOU14TA114
SOUAnE FOOTAO.E, WASI JER
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'SEnVICE (AMPS) - DnYER, • '
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frit=EZEti
PLUI,ADII70:
T OI
OAS Plf'IIJQ 0<
BIDET
wAi En I IEAl.Er1
URLfJALS
SEWAGE DISPOSAL
LAVS '
I IUUSE SEWEri .
$1 IOWERS
Root DMINS
..BATHTUBS
FLOOR'DRAINS
FLOOR SINK
-
_
KITCHEN SINK
LAUNDRAY TRAY
SINKS