003257 (SFD)IV
44
P.O. BOX 1504 No, 003257
Building 78-105 CALLE ESTADO
Address 54"•885 Inverness LA QUINTA, CALIFORNIA 92253
Owner - -.
Mailing
BUILDING:^TYPECONST. OCC: GRP.-
Address cln" t-ry r -111'r) i von
A.P. Number T)r.A w1',_4_ q
-
City
Zip ` .
Tel.
Pal sI . !h;MqP
Minimum Setback Distances:
16 Ate? A 2R_
Legal. Description
Project Description ub,4 <tea �72n 'P1 /r$vx
An!'4
Contractor
4.k
Side Street Setback from Center Line
_. _- _
Address
FINAL DATE
INSPECTOR
City
Zip
Tela .. _ .
Validation:
State Lic.
City
& Classif.
Lic. # 328
Sq. Ft. j VIG 3142 -No.
No. Dw.
_
Size -' r: i; �.� • Stories ` "
Units
Arch:; Engr.,
~Add❑
Designer
New 0." 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.. .�..,—� s._��. �< ` )%' : r!
- �• _ - _
., _ .
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 Code: 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 file a signed statement that he is 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 theapplicantto a civil penalty of not more than live. -hundred dollars ($500).
O. 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;yBuisness 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- _
Estimated Valuation *�, A
P a �i�r very
$ .? 0
• PERMIT ^
=r.
'AMOUNT
PIanChk. Dep.-
'
-
Plan Chk. Bal. _
s .
Const.
'✓.. _
Mech. - -
r.v tin
Electrical
• 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.)
Plumbingv
❑ 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 of property who builds or improves thereon,- and who contracts for
such 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. 1.
_
Grading
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.
CERTIFICATE OF EXEMPTION FROM
_ WORKERS' COM P ENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100)' valuation
or less.) -
Lcertify 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.
Date Owner "—
NOTICE TO APPLICANT: If, after 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.
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.)
Lender's Name
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 is correct.
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
ateMailing Address
City, State, Zip
HARD COPY
TOTAL
REMARKS
`
ZONE:
BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE
INSPECTOR
Issued by;
Date 111 A /.Q**Permit
Validated by:
Validation: