003254 (SFD)7-2 P.O. BOX 1504
Building78-105 CALLE ESTADO
Address 5 I2TVarn'.S>S LA QUINTA, CALIFORNIA 92253
Owner
No. 003254
BUILDING: TYPE CONST. OCC. GRP.
Mailing
Address A.P. Number PGA W®stt
City Zip Tel.
Legal Description
Contractor Project Description pba2a =2a]34 Al An 101M /A
Address Le an'
City'
Zip
Tel.
State Lic.
& Classif. . 288130
City
Lic. # 328
Sq. Ft. DWG 2272
No. No. Dw.
Size CAR 582
Stories Units
Arch.; Engr.,
Designer..
New ❑ Add ❑
Alter ❑ Repair ❑ Demolition ❑
Address
Tel.
City
Zip
State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
1 hereby affirm thet`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
-
JIGNATURE - DATE
'
' OWNER -BUILDER DECLARATION
Estimated
1, hereby affirm that I am exempt from the Contractors License Law for the following
.Valuation
�'
reason: (Sec. 7031.5,Business and, Professions Code: Any.clty or county which requires a
permit to construct, after. 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
.- PERMIT
•• -' AMOUNT
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 Any Section 7031.5 'any
Plan Chk. Dep.
alleged exemption. violation of by applicant for a pemrlt
subjects the applicant to a civil penalty of not more than frvehundred dollars (E500). -
Plan Chk. Bal.
❑ 1, as owner of the property, or my employees with wages as their sole compensation, will
.64
do the work, and the structure is not Intended or offered for sale. (Sec. 7044, Buisness and.Const.Professions
Code: The Contractor's License Law does not apply to an owner of property who
bods or improves thereon and who does such work himself or through his own employees,
Mech.
-
. provided that such improvements are not Intended or offered for sale. d, however, the building
or improvement is sold within one year of completion, the owner -builder will have the burden
Electrical
of proving that he did not build or improve for the purpose of sale.)
'
❑ 1, as owner of the property, am exclusively contracting with licensed contractors to con-
Plumbing
28-50
struct the project. fSec. 7044, Business andProfessions Code: The Contractor's License Lew
does not apply to an owner of property who builds or Improves thereon, and who contracts for
S.M.L
'
such projects with a contractor(s) licensed pursuant to the Contractor's License Lew.)
Grading
OA am exempt under Sec B. 8 P.C. for this reason
Driveway Enc.
Date owner
Infrastructurei
5 6 q, _53
WORKERS' COMPENSATION DECLARATION
1 hereby affirrn'that 1 have a certificate of consent to selfAnsure, or a certificate of
Workers Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No Company
—:::i❑
Copy is filed with the city. ❑ Certified copy is. hereby furnished.
TOTAL
% 3 2 • �/ _
CERTIFICATE OF EXEMPTION FROM
'REMARKS
WORKERS'COMPENSATIONINSURANCE
(This section need not be completed ff the permit is for one hundred dollars (E100) valuation
• or Mss.) -
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.
tr - LN« it iii. '� • • S
Date Owner "
NOTICE TO APPLICANT: fl, after making this Certificate of Exemption you should become
ZONE:
BY:
subject to the Workers"'Compensetion provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shah 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
hereby affirm that there is a construction lending agency for the performance of the
work forwhich this permit is Issued. (Sec. 3097, Civil Code.)
Side Setback from Property Line
Lenders Name
Lenders Address
FINAL DATE
INSPECTOR
This Is a building permit when properly filled out,signed and validated, and is subject to
expiration if work thereunder Is suspended for 160 days.
1 certify that 1 have read this application and state that the above information is correct.
1
Issued by:
Date73Permit
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.
Validated by:
Signature of applicant Date
Mailing Address
Validation:
City, State, Zip
HARD COPY