003252 (SFD)fiV
P.O. BOX 1504 No.. 003252
Building -78-105 CALLE ESTADO
Address 54-853 lnveL"ue6s LA QUINTA, CALIFORNIA 92253,
Owner
Sunrise Convi a1' v
Mailing BUILDING: TYPE CONST. OCC: GRP.
Address 74—Af' q �,, �T+�4,�-cr ` 1,kslki�r+�rs� A.P. Number W'. YiT�aJ.Q4-
City Zip _ Tel. -. -
:__ TY»txn .. d��:irta3�.. Legal Description
Contractor Project Description i F1WftG+
Address. -
..City lZip' Tel..
State Lic. City
& Classif.2861*50- Lic. # Sq. Ft. DWG� 2 No. No. Dw.
Size - =�� - -,.... - Stories • Units—ATCh., Engr.. �xra,r� y0
'. Designer. New ❑ Add O Alter O Repair O Demolition O
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 r
7000) of Division 3 of the Business and Professions Code, and my license is in full force and _-
effect.v.C`%9'`i`r'
' SIGNATURE - DATE _
OWNER -BUILDER DECLARATION EStlrriated Valuation .
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec.. 7037, 5, Business and Professions Code: Any city or county .which requires. a - rc'1I SR
I. 1546.0
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 PERMIT 'AMOUNT
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Division 3-ol the Business and Profession's Code, or. that. he is exempt therefrom:' and the basis
for the alleged exemption. Any violation - of Section 703 1. 5 by 'any applicant for a' permit Plan Chk. Dep. -
. subjects the applicant to a clvll penalty of not more'than five hundred dollars ($500). •'• . -
O I,'as, owner of the property, or•my employees with wages as their sole compensation, will Plan Chk..Bal.
do the work, and the structure is not intended or offered for sale. (Sec. 7044,. Buisness and vM
Professions Code: The Contractor's License Law does -nota I to,an owner of property who Const. ,qq
PPY P P Y AC'at4
builds or improves thereon and who does such work himself or through his own employees, Mech. 5
.provided that' such improvements are not, intended, or offered for sale. ll, however, the building "
or improvement is sold within one year of completion, the owner -builder' will have. the burden EleCtrlCal '
or proving that he did. not build or improve for the purpose of sale.)
O I, as owner of the property, am exclusively contracting with licensed contractors to con. Plumbing 3.
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 S.M.I. �''
such projects with a-contractor(s) licensed pursuant to the Contractor's License Law.)
Grading
O 1 am exempt under Sec. B. t;, P.C. for this reason
Driveway Enc.
Dace owner Infrastructure 2 000 400
WORKERS' COMPENSATION DECLARATION
kehereby affirm that I have a certificate of consent *to -self-insure, or a certificate of
Worr's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.) -
Policy No. .Company
.O Copy is,filed with the city.. O Certified copy is hereby furnished.
TOTAL
CERTIFICATE OF EXEMPTION FROM REMARKS
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars (5700) valuation -
• or less.) - - ��•
I certify that in the performance of thg work for which this permit is issued, I shall not ' ; :� -� �`vg yryf.p';1:� "- 3ri . Zf 1Z
employ any person in any manner so as to become subject to the Workers' Compensation
Laws of California.
Date Owner
NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become ZONE: BY:
subject 'to the Workers' Compensation provisions of the Labor Code, you must forthwith- Minimum Setback Distances:
comply with such provisions or this permit shall be deemed revoked. - -
Front.Setback from Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY Side Street Setback from Center Line
I hereby affirm that there is a construction lending•agency'for the performance of the
work for which this permit is issued. (Sec. 3097, Civfl.Code.) Side Setback from Property Line
Lender's Name
Lender's Address
This is a building permit when properly filled out, signed and validated,'and is subject. to' FINAL.DATE INSPECTOR
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. Issued by: Date 7 1 2 i1 1 :,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. Validated by:
Signature of applicant Date
Mailing Address Validation:
City, State, Zip
HARD COPY