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09039 (PAT)Building Owner 414 W P.O. BOX 1504 t Wo. . 78-105 CALLE ESTADO LA QUINTA, CALIFORNIA 92253 Mr. and firs � Wali ©�nnA BUILDING: TYPE CONST. OCC: GRP. Mailing Address 55-063 Inverness City Zip La-Quinta 92253 Contractor Jesse Jimenez General BI Address. 82-'-4I0 Dr. Cas=e©n Blvd. City Tzip A.P. Number 09039 L , Legal Description Contractor Project Description T.^tti c"_e 13pitdn F_rl,famy- State Lic. City & Classif.Lic. 5586:73 B # 1790 Sq. Ft. Size 96 No. No. Dw. Stories Units Arch., Engr., New ❑ Add ❑ Alter ❑ Repair ❑ -Demolition ❑ Designer 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 70 ) of Division 3 of the Business and Professions Code, and my license is in full force and e e r 'r"t SGNATUR f-"- GATE - t J OWI -BUILDER DECLARATION 1 hereb 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 the applicant to a civil penalty of not more than five hundred dollars ($500). ❑,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 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, . • r 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 i0 proving that he did not build or improve for the purpose of sale.) Estimated Valuation 1, 1 Qfl 'W PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. Const.Q 00 Mech. Electrical 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 Sec. B. 8 P.C. for this reason S•M•1• .14 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. O Certified copy is hereby furnished. TOTAL 45 i - CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE REMARKS C3f'1j.�j"3 #L`. ,�}f1(j..l;< j,--(Zwi�7(; (This section need not be completed if the permit is for one hundred dollars ($100) valuation or less I certify rtify that in the performance of the work for which this permit is issued, I shall not employ anyperson 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. 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.) Lender's Name FINAL DATE Side Street Setback from Center Line Side Setback from Property Line INSPECTOR 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. Issued by: Validated by: Date Permit Signature of applicant Date Mailing Address Validation: ..ti k City, State, Zip