003266 (SFD)Building
Address 54--843 Inverness
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
Mailing
Address 75-005 country' Club ftivb
City Zip Tel.
Paha Deserti.. 92266' 558-2828
Contractor
Address _
City Izip I Tel.
No. 003266
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number $'A West
Legal Description _
Project Description Phase Plan 20MR
State Lic.
& Classif. 288130
City
Lic. # 328
Sq. Ft. D
Size. •. - GA
2596 No. No. Dw.
. •5-7T Stories Units
Arch., Engr.,
Designer
New ❑ Add ❑ Alter ❑' Repair ❑ Demolition ❑
Address
Tel.
City
State
]Zip
Lic. #
• LICENSED CONTRACTOR'S DECLARATION
ec
�.
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 Contractor's License law for the following
reason: (Sec. 7031.5,Business and Professions Coder Any city or county which requires a
permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance also
requires the applicant for -such permit to rile a signed statement that huts licensed pursuant to
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 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 ($500):
0 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 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. build or improve for the purpose of sale.)
Estimated Valuation
.- _-
.PERMIT - AMOUNT
-
Plan Chk. Dep.- ,
Plan Chk. Bal. S 525. In
.-
COr1St' 33
Mech. . 55. 0f)
-
. Electrical - 3 - n f
Plumbing
1 ��
❑ 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
projects with a contractor(s) licensed pursuant to the -Contractor's License Law.) -
O..I am.exempt under Sec. B. & P.C. for this reason
S.M.I.5%such
_-
Grading
Driveway Enc.
Date Owner
Infrastructure
2,000.00
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. O Certified copy is hereby furnished.
-13,471. J
TOTAL
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE•
REMARKS
(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 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.
-
rigt
r:-;7r`1i1 ;�f�r'f{"zY '1 2? .6 �?
Date -L-----' ' Owner
NOTICE TO APPLICANT: If, alter making this Certificate of Exemption you should become
-subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
ZONE: BY:
Minimum Setback Distances: '
Front Setback from Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY
I hereby 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 Street Setback from Center Line
Side Setback from Property Line
Lender's Name
FINAL DATE
Issued by:
Validated by:
INSPECTOR
Date 7 /2n./A Permit
Lender's Address
This is a building permit when properly filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days.
I certify that I have read this application and state that the above information incorrect.
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
Validation:
City, State, Zip
HARD COPY