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06911 (SFD)P.O. BOX 1504 No. 06911 Building 7:$-510 Via Sonata 78-105 CALLE ESTADO Address LA QUINTA, CALIFORNIA 92253 Owner BARCOW DEVELOPFaT Mailing BUILDING- TYPE CONST. OCC: GRP., Address 68-713 Perez Roam, #1rr��555-4. Ptia5e IV A.P. Number City Cathedral LT is Zip RL -134 Tel 3-9UZ4 Contractor Tela State Lic.x:31 tD! 1 I City & Classif. Lic. # Arch., Engr., ' Designer Address Tel. . IState Lic. # ',-" LICENSED CONTRACTOR'S DECLARATION hereby affirm that 1 am licensed,undei provisions of Chapter 9 (co mm encing willf Sectio OD) Dof ivision°3 of the Business arhd,Professions Code, and mi license is in,ful f force aK yf f•%'~1P's''ii'D.�'�.f,/p+F :.moi''_ :"A, i OWNER -BUILDER DECLARATION 1 hereby affiryn that I am exempt from the Contractors License law for the following reason: (Sec. 7031.5,6ustress and Professions Code: Any city or county which requires a Permit to construct, at-, irprove, demolish, or repair any structure, prior to its issuance also requires the app5cant for such permit to tie a signed statement that he is licensed pursuant to the provisions of am CanLactor's License Law, Chapter 9 (commencing with Section 7000) of Division 3 of the dress 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 appScant to a civi penally of ndt more than five hundred dollars (8500). ❑ 1, 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 Conhaaor'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 irprovements are not intended or offered for sale. If, however, the building or improvement is soled within one year of completion, the owner -builder will have the burden or proving that he did.rwt build or krprove for the purpose of sale.) ❑ 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 Contractor's License Law.) ❑ 1 am exempt under Sea a, & P.C. for this reason Date owner WORKED' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self -insure, or a certificate of Workers Compensation Insurance, ora certified copy thereof. (Sec. 3800, Labor Code.) Policy No Company ❑ Copy is filed with the city. ❑ Certified copy is hereby furnished. Legal Description Project Description Plan -.W LA QUINIA 1140 Els Lot #11 WORKED' COMPENSATION INSURANCE (this section need not be completed ff the permit is for one hundred dollars ($100) valuation ,!1 _00 }i- ,.;3,t) Or less.) 1 certify that in the performance of the work for which this permit is issued, I shall not A is CtiKai w i.3 G Yi>• 1. t.... r > .: .. employ any person in any manner so as to become subject to the Workers' Compensation 91 Sq. Ft. Size •- No. No. Dw. Stories Units New Add ❑ Alter ❑ Repair ❑ Demolition ❑ NOTICE TO APPLICANT: ff, after making this Certificate of Exemption you should become ZONE: BY: subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. Minimum Setback Distances: ' Front Setback from Center Line Rear Setback from Rear Prop. Line CONSTRUCTION LENDING AGENCY Side Street Setback from Center Line 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, CM Code.) Side Setback from Property Line Estimated Valuation $68,574 PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal.= Const. ^ •_� Mech. • Electrical Plumbing 6 S.M.I. 4• 23 Grading Driveway Enc. Infrastructure 1,992.92 TOTAL CERTIFICATE OF EXEMPTION FROM REMARKS WORKED' COMPENSATION INSURANCE (this section need not be completed ff the permit is for one hundred dollars ($100) valuation ,!1 _00 }i- ,.;3,t) Or less.) 1 certify that in the performance of the work for which this permit is issued, I shall not A is CtiKai w i.3 G Yi>• 1. t.... r > .: .. 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 Exemption you should become ZONE: BY: subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. Minimum Setback Distances: ' Front Setback from Center Line Rear Setback from Rear Prop. Line CONSTRUCTION LENDING AGENCY Side Street Setback from Center Line 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, CM Code.) Side Setback from Property Line Lenders Name Lenders Address This is a'building permit when property filled out, signed and validated, and is subject to expiration if work thereunder is suspended for 180 days. I car tity that 1 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 FINAL DATE INSPECTOR Issued by: Date ft Perm Validated by: Validation: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SO. FT- $ : UNITS ` SLAB GRADE IfA7 ROUGH PLUMB. BONDING YARD SPKLR SYSTEM 2ND FL SO. FT. FORMS SEWER OR SEPTIC TANK 3 ROUGH WIRING. MOBILEHOME SVC. BAR SINK POR. SQ. FT. ® GAS (ROUGH) K A a Y METER LOOP 1 POWER OUTLET ROOF DRAINS GAR. SQ. FT. ® GAS (FINAL) TEMP. POLE DRAINAGE PIPING CAR P: Sp. FT. @ WATER HEATER SERVICE FINAL INSP. BOND BEAM DRINKING FOUNTAIN. WALL SQ. FT. GRADING cu. yd. $ -Plus-x$-=$ LUMBER GR. FINAL INSP. � 0 URINAL SQ. FT. @ ROOFING (" ESTIMATED CONSTRUCTION VALUATION $ WATER PIPING NOTE: Not to be used as property tax valuation FLOOR DRAIN MECHANICAL FEES WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED 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 FINISH GRADING SQ. FT. @ c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SQ. FT. RESID ® 1+/a c SEWAGE DISPOSAL SO.FT.GAR ® �/ac HOUSE SEWER GAS PIPING PERMIT FEE 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 a UNDERGROUND A.C. UNIT COLL. AREA SLAB GRADE IfA7 ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMS SEWER OR SEPTIC TANK 3 ROUGH WIRING. DUCT WORK ROCK STORAGE FOUND. REINF. GAS (ROUGH) K A a Y METER LOOP 1 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. � 0 FRAMING 114 O FINAL INSP. p� ROOFING (" (/ Y i _ REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL RING MESH INSULATION/SOUND 0 FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL - INSPECTOR'S SIGNATURESIINITIALS - GARDEN WALL FINAL 1