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04260 (SATT)T4t�l 4 4 Q" Building Terra Cotta Ct. Address Owner �JiAevard r"eveloL)r=1eY't P.O. BOX 1504 78-105 CALLE ESTADO LA OUINTA, CALIFORNIA 92253 Mailing Address 777 31. "Tai'3 %,t. q Suite .14r3 City Zip Tel. Contractor ai"'2 ress State Lic. 28 I City & Classif. Lic. # Arch., Engr., Designer Address Tel. City I Zip I State J Lic. # ! LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) t.of effecDivision 3 of the Business and Professions Code, and my license is in full force and SIGNATURIE DATE OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason: (Sec. 7031.5,Buslness 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 pursuanl to the Provisions at the Conlraclor's License Law, Chapter 9 fcommencing with Section 7000) of Division 3 of the Business and Professions Code., or that ha 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 penally of not more than five hundred dollars (S500). ❑ 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, Bussness and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or bnproves 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 ) ❑ 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 contractor(s) 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 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. ❑ Certified copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if Ina permit is for one hundred dollars (S100) vakration or lass.) 1 certify that In the performance of thV work for which this permit is issued, I shall not employ any parson in any manner so as to become subject to the Workers' Compensalion Laws of Gal liiornI& Date Owner NOTICE TO APPLICANT: 7f. alter making this Certificate of Exemption you should become subject to the Workers' Compens0on provisions of the Labor Code, you must forthwith comply with such provisions or this Permit shad! 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 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. Signature of applicant Date Mailing Address City, State, Zip _ BUILDING: TYPE CONST. OCC. GRP. A.P. Number 512- i 41- Legal Description Project Description Sq. Ft. 6.No. No. Dw. Size 7? Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. Cionst. Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure •4 p .;. TOTAL + • REMARKS ZONE: 8Y: 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 INSj?�T�1 Issued by: Date �� Permit Validated by: WHITE - FINANCE, PINK - APPLICANT, GREEN - BUILDING, GOLDENROD - ASSESSOR'S OFFICE, HARD COPY - FILE CONSTRUCTION iST FL SO FT (p 2ND FL SO FT a POR SO FT or GAR SO FT V CAR P SO FT 6 WALL SO FT Fd SO FT fd ESTIMATED CONSTRUCTION VALUATION NOTE Not to be used as property tax value MECHANIC VENT SYSTEM FAN EVAP.COOI APPLIANCE FURNACE UNIT WALL FLOOR AIR HANDLING UNIT ABSORPTION SYSTEM COMPRESSOR HP HEATING SYSTEM FORCED BOILER B T.0 MAX HEATER OUTPUT, B T U PERMIT FEE DBL TOTAL FEES STRUCTURE SETBACK LA8 GRADED �7 FORMS ❑UND REINFf r% � REINF STEEL GROUT BOND BEAM LUMBER GR . .''FRAMING�.{G ROOFING v VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR G FIREWALL G MESH fF:`'INSULATIONISOUN❑ FINISH GRADING FINAL INSPECTION 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 FLOOR DRAIN ion 1L FEES WATER SOFTENER HOOD ISIGN WASHER(AUTONDISH) DRYER GARBAGE DISPOSAL SUSPENDED LAUNDRY TRAY KITCHEN SINK CFM BTU TEMP USE PERMIT SVC WATER CLOSET POLE, TEMIPERM LAVATORY 3RAVITY AMPERES SERV ENT SHOWER SO FT ®c BATH TUB SO FT a c WATER HEATER SO FT. RESID a 11/, c SEWAGE DISPOSAL SO FT GAR a 3i c HOUSE SEWER GAS PIPING PERMIT FEE PERMIT FEE MICRO FEE MECH.FEE PL CK.FEE CONST FEE ELECT FEE SMI FEE PLUMB FEE PLUMBING i OUND PLUMBING/% —, ROUGH PLUMB SEWER OR SEPTIC TANK GAS (ROUGH) GAS (FINAL) WATER HEATER WATER SYSTEM FINAL INSP ELECTRICAL UNDERGROUND BONDING ROUGH WIRING METER LOOP TEMP POLE SERVICE FINAL INSP HEATING & AIR COND A.C. UNIT HEATING (ROUGH) DUCT WORK HEATING (FINAL) FINAL INSP GRADING cu yd. $ plus x$ REMARKS: SOLAR COLL. AREA STORAGE TANK ROCK STORAGE OTHER APP.IEOUIP GARDEN WALL FINAL