003262 (SFD)P.O. BOX 1504 No. 003262
Building 78-105 CALLE ESTADO
Address 54-869 .In[%E3i ems. LA QUINTA, CALIFORNIA 92253
Owner- - ,.... ..... _.. .. , .. _. .. _
Sunrise coni' n
Mailing BUILDING: TYPE -CONST -.—OCC. GRP.
Address r%_nAr. ,tro7«*u lm"4.I►n A.P. Number
City Zip Tel. - _ . _ .. •• .. '�' ..
Palm Desert.322 8 5��-2828 Legal Description
ContractorProject Description P9A WAst — 'Phn—ge 29 -SP F'�art
National Martanca Loan
Address . . . - _ - - . .
City - . � .. _. .. Zip - - Tel.' -
State Lic. City
& Classif.�$ � Lic. # Sq. Ft. DW(; 3854 No. No. Dw.
32.9 Size r g1g. _ Stories_ _ : Units
Arch.; Engr.; . _.. - - - —
• Designer New ❑ Add ❑ Alter ❑ Repair ❑ - Demolition ❑
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?'
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_ SIGNATURE `d • DATE
_
' OWNER -BUILDER DECLARATION
Estimated Valuation
I hereby affirm that I am exempt from the Contractor's License law for the following
Z 3
$215v133
reason: (Sec. 7031.5,Business and Professions Code: Any -city, or county which requires a
permit._fo construct, after, improve, demolish• or repair any. structure, prior to its issuance also
...
requires the applicant /or such permit to file a signed statement that he is•Iicensed pursuant to
- PERMIT +AMOUNT
the provisions of*the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Division 3 o/ the 'Business and Professions Cdde,'Or that. he /s exempt therefrom• and the basis
for the Any Section 7031.5 'any
- '
Plan Chk. Dep.
alleged exemption. violation o/ by applicant /or a permit
subjects the applicant to a civil penalty o/ not more than five hundred dollars ($500).
Plan Chk. Bal.
❑' 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
y
Const.
Professions Code: The Contractor's License Law does not apply to an owner of property who
.hjmself
s . u
builds or improves thereon and who does such work or through his own employees,
MBCfI.. L Aey
provided that such Improvements are not intended or, of/ered /or sale. If, however, the building
56 w
or improvement is sold within one year o/ completion, the owner -builder will have the burden
Electrical '12 q 0 7 4
of proving that he did not build or improve for the purpose o/ sale:)
.
O I, as owner of the property, am exclusively contracting with licensed contractors to con•
Plumbing ��IFi.
strucl the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law
..
does .not apply to an owner o/ property who builds or improves thereon, and who contracts for
S.M.I. •" �,'5
• • such projects with a contractor(s) licensed pursuant -to the Contractor's License Law.)
Grading
❑ I.am exempt under Sec. B. & P.C. for this reason
Driveway Enc.
Date Owner
Infrastructure
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. 3800, Labor Code.)
Policy No: Company
❑. Copy is filed with the city. ❑ Certified copy is hereby furnished.
TOTAL 62A '7 r,
_
CERTIFICATE OF EXEMPTION FROM
REMARKS
WORKERS'.COMPENSATION.INSURANCE
(This section need not be completed it the permit is /or one hundred dollars ($100) valuation
or less.) .. .. .. ..
I certify that in the performance of thg work for which this permit is issued, 1 shall not
. 'STe.x .i�¢... ,� • fir}
employ any person in any manner so as to become subject to the Workers' Compensation
Laws of California.
Date Owner
NOTICE TO APPLICANT. I/, after making this Certificate of Exemption you should become
ZONE: BY: -
' subject to the Workers' Compensation provisions o/ 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
Ihereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, Civil Code.) -
—Side Setback from Property Line .
Lender's Name
Lender's Address
'
FINAL DATE INSPECTOR
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 certify that I have read this application and state that .the above' information is correct.
Issued by: Date K! %1Permit
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 enterthe above-
mentioned property for inspection purposes.
Validated by:
Signature of applicant Date
Mailing Address
Validation:
City, State, Zip
HARD COPY