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15781 (BLCK)Building Address .50-180 Owner�� 4 P.O. BOX 1504 78-495 CALLE TAMPICO MONTANA LA QUINTA, CALIFORNIA 92253 Mailing Address Same as Above City Zip Tel. 1.0 Quanta 1 1 92253 Contractor Tom Stone 'Masonry Address P.O. Box 1333 City' Zip Tel.. La Qui.nta. 92253 564-2128. State Lic.4 ��.� City & Classif.. Lic. # 1228 Arch., Engr., 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) of Division 3 of the Business and Professions Code, and my license is in full force and effect. SIGNATURE DATE OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractors 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 rile a signed statement that he is licensed pursuant to the provisions or the Contractor's License Law, Chapter 9 (commencing, with Section 7000) of Division 3 o 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 (8500). ❑ 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 building or Improvement is sold within one year of completion, the owner -builder will have the burden of proving that he did not bulli or improve for the purpose of sale.) O 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 or property who builds or improves thereon, and who contracts for such projects with a contractors) (#tensed pursuant to the Contractor's License Law.) O 1 am exempt under Sec. B. & P.C. for this reason Date, Owner WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to seWinsure, 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' 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 No. 15781 BUILDING: TYPE CONST. OCC: GRP. A.P. Number Legal Description' Project'Description 501 .X 41 Garden Fall 681 X 24`0- Garden wall Date Owner . _ NOTICE .TO APPLICANT: ff, after making this Certificate of Exemption' you. should become ZONE: t 'l 'BY: f VA 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: ' Sq. Ft. Size No. Stories No. Dw. Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ - Side Street Setback from Center Line SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000),INADDITION TO THE COST OF COMPENSATION, Side Setback from Property, Line DAMAGES AS PROVIDED FOR IN SECTION 3706 OF'THE LABOR CODE, INTEREST, AND ATTORNEYS FEES. Estimated Valuation $800.00 INSPECTOR PERMIT AMOUNT Plan Chk. Dep. `• Issued by'.. Date Permit Plan Chk.. Bal. Const. $25. . Mech. Validated by: Electrical Plumbing ' ..Validation: S.M.I. Grading Driveway Enc. Infrastructure TOTAL �. REMARKS ' Date Owner . _ NOTICE .TO APPLICANT: ff, after making this Certificate of Exemption' you. should become ZONE: t 'l 'BY: f VA 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 WARNING: FAILURE To SECUREWORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND Side Street Setback from Center Line SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000),INADDITION TO THE COST OF COMPENSATION, Side Setback from Property, Line DAMAGES AS PROVIDED FOR IN SECTION 3706 OF'THE LABOR CODE, INTEREST, AND ATTORNEYS FEES. " This is a building permit when properly filled out, signed and validated, and is subjecCto FINALDATE INSPECTOR expiration it work thereunder is suspended for 180 days. .. I cartify.that I have read this application and state that the above information is correct. " Issued by'.. Date Permit 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. ' ' . r Validated by: Signature of applicant Dater Mailing Address ..Validation: City, State, Zip CONSTRUCTION ESTIMATE ` NO. ELECTRICAL FEES NO. PLUMBIW FEES 1ST FL. SO. FT. ® $ 2ND FL. SO. FT. ®` POR. SO. FT. ® GAR. SO. FT. ® CAR P. SO. FT. ® WALL SO. FT. ® SO. 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 WASH ER(AUTO)(DISH) APPLIANCE DRYER GAS (ROUGH) GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED OTHER APPJEOUIP. LAUNDRY TRAY 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 SO. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 1+/a c SEWAGE DISPOSAL SO.FT.GAR ® 3/ac HOUSE SEWER REMARKS: 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 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 INSULATIONISOUND FINISH GRADING INAL INSPECTION/0 CERT. OCC. FENCE FINAL INSPECTOR'S SIQNATURESlINITIALS GARDEN WALL FINAL