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15561 (SFD)41 Building Address 50 X62 P�o13xsv.� ir. (lwnur 4-4 P.O. BOX 1504 N o . '15.561. 00" a 76-495 CALLE TAMPICO adows LA OUINTA, CALIFORNIA 92253 Mailing - - Address 50-445 Mountain Shadows City Zip Tel. La Quinta 1 92253 1 564-7818 Contractor same ar. above ress City lZip I Tel.: State Lic. I City & Classif.. 693899 Lic. # 3625 Arch., Engr., Designer DBIG Address Tel. 26 C'o.rpgrage Pars 714-26.1-1795 City Zip State Irvine • 92714 Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section of Division 3 of the Business and Professions Code, and my license is in full force and effect. 'F SIGNATURE DATE OWNER -BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractor's License Law for the following reason:. (Sec. 7031.5,8usiness and Professions Code: Any city or county which requires a 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 the provisions of the Contractor's License taw, 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 Ove 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 taw 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.) - O 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 such projects with a contractors) licensed pursuant to the Contractor's License Law.) ❑ 1 am exempt under Sec B. & P.C. for -this reason Date Owner WORKERS' COMPENSATION DECLARATION I hereby affirm that 1 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' COMPENSATION INSURANCE (This section need ,not be completed B 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. UILDING: TYPE CONST. - OCC: GRP. R3 .P. Number 769- 55.2 egal Description Lot- 9 rarzt 25429 roject Description SFD Sq. Ft. Size Newya No. No. Dw. Units Add ❑ - . Alter ❑ - Repair ❑ -Demolition ❑ Permit does bioek waif. a Valuation17� •�� I: PERMIT ' r\A - Plan Chk. Dep.' • 250"' Plan Chk. Bal. II W. Const. . Mech. DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND Electrical (, 0QC( I I � t7 U 1995 I I Plumbing DATE. S.M.I. This is a building permit when properly filled out, signed'and validated, and is subject to Grading Driveway Enc. Infrastructure I certify that I. have read this application and state that the above information is correct. • Issued by:- Date Permit I agree to comply with all city and county ordinances and state laws relating to building �r] construction, and hereby authorize representatives -of this city to enter the above-. TOTAL Validated by: AMOUNT 503. ()*a 991.50 102_50 175.50 17_1° 3747.33 1 '7 Q .. 7'T.. REMARKS 1I.vr.m 'hers . V" h1 » e 131 V-eir%i,! 4- r+t a e�n4s��rl# tsi +b :p1 aentr% » s1= na&mt _ And �-''{3.�� 'r�ca°f It ;� i^r1r.r,.�1-v'-o�6'•,4 Sir! ZONE: BY: Minimum Setback Distances: Front_Setback-ffom Center Line /Rear Setback fr6m Rear Prop. Line WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND r\A - /_r=Side Street Setback from Center Line SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE I i J I II W. HUNDRED THOUSAND DOLLARS ($100,()00), IN ADDITION TO THE COST OF COMPENSATION,. . Side Setback from' Property Line J1 DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND (, 0QC( I I � t7 U 1995 I I ATTORNEY'S FEES. `FINAL DATE. :. v Id 1 INSPECTOR 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. • Issued by:- Date Permit I agree to comply with all city and county ordinances and state laws relating to building �r] construction, and hereby authorize representatives -of this city to enter the above-. mentioned property for inspection purposes. Validated by: Signature of applicant Date Mailing Address -0- Validation: City, State, Zip 9 CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBINU FEES IST FL. SO. FT. ® $ S0. FT. POR. SO. FT. ® GAR. SO. FT. ® CAR P. SO. FT. WALL SD. FT. SO. FT. ® ESTIMATED CONSTRUCTION VALUATION $ UNITS MOBILEHOME SVC. POWER OUTLET YARD SPKLR SYSTEM BAR SINK ROOF DRAINS DRAINAGE PIPING DRINKING FOUNTAIN URINAL WATER PIPING NOTE: Not to be used as property tax valuation HEATING (ROUGH) STORAGE TANK FLOOR DRAIN MECHANICAL FEES WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER REINF. STEEL GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED LAUNDRY TRAY AIR HANDLING UNIT CFM KITCHEN SINK ABSORPTION SYSTEM B.T.U. TEMP USE PERMIT SVC WATER CLOSET' COMPRESSOR HP POLE,TEMIPERM LAVATORY HEATING SYSTEM FORCED GRAVITY AMPERES SERV ENT SHOWER BOILER B.T.U. SO. FT. ® c BATH TUB VENTILATION SO. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 11/4 c SEWAGE DISPOSAL SO.FT.GAR ® 3/ac HOUSE SEWER FIREWALL GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEE MECH.FEE EPL.CK.FEE CONST. FEE ELECT. FEE SMI FEE PLUMB. FEE STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR ETBACK ,22.0 OUND PLUMBIN /V UNDERGROUND A.C. UNIT COLL. AREA WLAB GRADE ,22 ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMS (SEWI)R'ORfr16 ROUGH WIRING DUCT WORK ROCK STORAGE FOUND. REINF. 5/(ROUGH) '%�_�f METER LOOP 66 HEATING (FINAL) OTHER APPJEOUIP. REINF. STEEL GAS (FINAL) JO�� - TEMP. POLE GROUT WATER HEATER SERVICE F NAL INSP. [�+ BOND BEAM WATER SYSTEM $ GRADING cu. yd. plus x$ _$ LUMBER GR. L� FINAL INSP. !J -�/ "—FRAMING �v/5� INAL INSP. L` OOFINGW! T6 w�� /� ,3%�� ,.✓ 1v-��-mss' ,b2� REMARKS: VENTILATION FIRE ZONE ROOFING ' FIREPLACE SPARK ARRESTOR FIREWALL RING •D" ��✓�j MESH SULATION/SOUND FINISH GRADING AL INSPECTION/,;—/ l S CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURES11NITIALS GARDEN WALL FINAL