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05395 (CP)T4tyl 4 4 Q" Building , Address Owner Mailing Address City Zip TeL Contractor Address City J.Zip ITel. State Lic. I City & Classif. fl Lic. # Arch., Engr., Designer Address I Tel. P.O. BOX 1504 78-105 CALLE ESTADO LA QUINTA, CALIFORNIA 92253 City Zip State Lic. # . LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 [commencing with Section T1)t)Dj of.pivisIoo 3 of the Busiruns. and Professions Code, and my license is in Full IDrCe and effect � �IGHATIIRE DATE OWNER -BUILDER DECLARATION I hereby alfiryn that I am exempt from the Contractor's license Law for the following reason_ ISec. 703f.5.6u&0ess and Professions Code. Any dry or county which requires a Permit 10 construct, aller, improve, donxYsh. or repair any sin ctwe, prior to as issumnca also requires the app/n 1 for such perms to file a mnipned statement Owl be is licensed pursuant to the provisions of the Confractors License Law, Chapter 9 (canvnencing with Section 7000) of ,'vision 3 of the Business and Professions Code, or that he is exempt thpe mm. and The basis toy the a9eged exemption. Any violation of Section 7031.5 by any Wphbanf for a porrut subjects the appNnnf to a ciO penalty of nor more than five fxmdrerf dosars (S500). El 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. (Sac 7044, fluisness and Professions Code-, The Contractor's license law does not apply to an owner of property who Wilds or Unproves thereon and who does such work hinseil or through his own amployees, Provided that such knpmvornunis are nor knended or offered far sale. 11, however, the building or improvement is sold withh one year of carplelion, the owner-hu7der wiiT have the burden 00 pmving that he did not build or kWmve for the purpose of sare.J ❑ I, as owner of the property, am exclusively contracting with licensed contractors to con- struct the project. fSec- 7044. Business and Proleslanns Code., The Confroclors License Law does not apply to an owner of property who buffs or inproves thereon, and who contracts for such projects with a conlractor(s) Fcensed pursuant to the Contractor's License Law.) ❑ 1 am exempt under Sec a- tf P-C_ for this reason Date Owner WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to sell -insure, or a certificate of Workers Compensation Insurance, or a certified copy fhersof..(Seo; 3800. Labor coda.) Policy No —company ❑ Copy is filed with the city- ❑ Certified copy is hereby furnished. CERTIFICATE OF EXEMPnON FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed i/ the permit is for one hundred dollars ($100) valuation or less.) I mrlffy that in the performance of thg work for which ]his permit is issued, I shall not employ any person in any manner so as to become subject to the Workers' Compens-ation Laws of California Dat —Owner NOTICE TO APPLICANT. If. efler making bWs certificate of Exerph-vn you should become subject to the Workers' Compensation pnn** B of the Labor Cede, you must forthwith comply with such provisions or this pemmd shag 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- 3007, Cirri Code.) Lender's Name Lender's Add This is a building perndl when property filled out, signed and validated, and is subject to expiralion 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 slate laws reieting to building construction, and hereby authorize representatives -of this city to enter the above menlioned property for inspection purposes Signature of applicant— Date Mailing Address — City, State, Zip BUILDING: TYPE CONST- OCC. GRP. A.P. Number Legal Description Project Description Sq. Ft. Size No. No. Dw- Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. Const. Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure 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 Permit Validated by: Validation: CONSTRUCTION 1ST FL, SQ. FT. 2ND FL. SO. FT. POR. SQ. FT. GAR. SQ. FT. CAR P. SQ. FT - WALL SQ. FT. SQ. FT. ESTIMATED CONSTRUCTION VALUATION NOTE: Not to be used as property tax valua MECHANIC VENT SYSTEM FAN EVAP.COOI APPLIANCE FURNACE UNIT WALL FLOOR AIR HANDLING UNIT ABSORPTION SYSTEM RESSOR HP ING SYSTEM k FORCED R B.T.U. IMAX. HEATER OUTPUT, B.T.U. IPERMIT FEE rBL I TOTAL FEES STRUCTURE SETBACK SLAB GRADE FORMS FOUND. REINF. REINF. STEEL GROUT BOND BEAM LUMBER GR. FRAMING ROOFING VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATIONISOUND FINISH GRADING FINAL INSPECTIONZ^Z CERT. OCC. FENCE FINAL ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES $ UNITS YARD SPKLR SYSTEM MOBILEHOME SVC. BAR SINK POWER OUTLET ROOF DRAINS DRAINAGE PIPING DRINKING FOUNTAIN URINAL $ WATER PIPING :ion FLOOR DRAIN 1L FEES WATER SOFTENER HOOD SIGN WASHER(AUTO)(DISH) DRYER GARBAGE DISPOSAL SUSPENDED LAUNDRYTRAY KITCHEN SINK CFM B.T.U. TEMP USE PERMIT SVC WATER CLOSET POLE, TEMIPERM LAVATORY 3RAVITY AMPERES SERV ENT SHOWER SQ. FT. ®c I BATH TUB SO. FT. ®c I WATER HEATER SQ. FT. RESID ® 11/4 c SEWAGE DISPOSAL SQ.FT.GAR ® 3/ac HOUSE SEWER GAS PIPING PERMIT FEE PERMIT FEE MICRO FEE MECH.FEE PL.CK.FEE CONST. FEE ELECT. FEE SMI FEE PLUMB. FEE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR LMBING GROUND A.C. UNIT COLL. AREA PLUMe.�� G 6 L- 'e HEATING (ROUGH) STORAGE TANK SEWER OR SEPTIC TANK ROUGH WIRING DUCT WORK ROCKSTORAGE GAS (ROUGH) S�Zr F ETER LOOP HEATING (FINAL) OTHER APPJEQUIP. GAS (FINAL) / TEMP. POLE WATER HEATER SERVICE FINAL INSP. WATER SYSTEM GRADING FINAL INSP. 2 ® 2 • cm. yd. �$—Plus—xs—=$ FINAL INSP. 1 REMARKS: (0t414 �f� /ac? 0 -3- (g- S1GNA GARDEN WALL FINAL