001994 (ELEC)Building 55-235 TmMMSS
Address
Owner
4
P.O. BOX 1504 No.. 001994
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
Mailing
Address 7s --04r5 MWItxy Club Dr.
CityZip Tel.
palm� 941"Mo %8-2928.
Contractor
... . rr & # 9 ,.A T sash
State Lic.
& Classif.
Arch., Engr.,
Designer
Address
Zip. Sam -- Tel: Sam
BUILDING: TYPE•CONST. '
A.P. Number
Legal Description
Project Description TIM MW
OCC: GRP. -
City
Lic. # Sq. Ft. No. No. Dw.
Size Stories Units
I New ❑t Add ❑ Alter ❑ Repair ❑ Demolition ❑
Tel.
CityZip
BY:
State
Front Setback from Center Line
Lic. #
PeX9l {7k�
LICENSED gONTRACTOR'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./i'' r i ;; �.%s+'. :• �` ii�.%�
FINAL DATE
SIGNATURE DATE
Issued by:
- OWNER -BUILDER DECLARATION
Validated by:
Estimated V81Uat10
I hereby affirm that I am exempt from the Contractor's License Law for the following
Validation:
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a
A 3) 8 4
permit'to construct,* after, 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
PERMIT
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 Any Section 7031.5 any. for
Plan Chk. Dep.
alleged exemption. violation of by applicant a permit
subjects the applicant to a civil penally of not more than five hundred dollars ($500).
Plan Chk. Bal.
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, Buisness and
Const.
• . 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,
Mech.
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
Electrical
of proving that he did not build. or improve for the purpose of sale.) - -
O I, as owner of the property, am exclusively contracting with licensed contractors to con-
Plumbing
estruct 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
S.M.I. '
such projects with a contractors) licensed pursuant to the Contractor's License Law.)
Grading
. ❑ I am exempt under Sec. 8. 8 P.C. for this reason
Driveway Enc.
Infrastructure
Date Owner
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate' of consent to self -insure, ora 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' COMPENSATION. INSURANCE
(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 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 it work thereunder is suspended for 180 days. -
I certify to
1 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. �fsss
Signature of applicant • ' 1' ' rr Date
Mailing Address
City, State, Zip
HARD COPY
TOTAL
REMARKS
AMOUNT
35.00
35.00
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"'" Permit
Validated by:
Validation:
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1 9 3 5. 0 C R