002517 (CP)Building
Address 54-902 Ali crew
Owner
sulaIrAft OWDOMW
Mailing
Address
City Zip '
Contractor
Address.
' City • Zip ..
State Lic.
& Classif.
,Arch., Engr.,
Designer
el.
I Lic. #
4
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
BUILDING: TYPE CONST:
A.P. Number
" - Legal Description
Project Description
No. .002517
_OCC: GRP.
Sq. Ft. No.
Size- Stories
New
No. Dw.
Units
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 Divisiom3 of the Business and Professions Code, andce and
sr�telicense is in full for
_ .
effect. : 4. --_v .'a''�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�+TJ1ake.1.�>J
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' -he is licensed pursuant to
the provisions of the Contractor's License Law, Chapter" 9 (commencing .wiIA Section •7000) of.
Division 3 of the Business and Professions Code, or thathe 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 rive hundred dollars (3500) ^
❑ 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 .
._ _ ,.
Estimated Valuation A Aq�E M
PERMIT AMOUNT
Plan Chk. Dep.
-
Plan Chk. Bal. 11.32
Const. �>�
MechyS
. 2G s 00
'EleCtrlCal� ��
•
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.) -
Plumbing ���
❑ 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.)
❑ I am exempt under Sea B. 8 P.C. for this reason
-_
S.M.I.��`
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
O Copy is filed with the city. ❑.Certified copy is hereby furnished.
p t
TOTAL 290 w i9
290.19
CERTIFICATE OF EXEMPTION FROM I
" 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.
r
_
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 she// 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 INSPECTOR
Issued by: -Date 8� Permit
+
Validated by:
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 inspeectionnnpurrpoosse�s: /.!� '
/ � F'f"•`� f�
Signature of applicant12 -fps' 5'� -:'.'Date
Mailing Address t
Validation:
A 6 1 4 1 8 6 25019 CC
City, State, Zip
HARD COPY