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08747 (RPL)Building Address Owner Mailing Address City Contraet&u-L11T-i2 �7443 a J t Add reb IalIt rnia Pools & Spas City — —.. —-[ZTr""' Tel. State E1el.f xs 1. eS43-rlc !;FIdA:vu City & Classif. Lic. # Arch., Engr., 18510' Designer Address Tel. 4 aCP Qum& - P.O. BOX 1504 78-105 CALLE ESTADO LA QUINTA, CALIFORNIA 92253 City I Zip I State Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under prgvlsions of Chapter 9 (commencing yrlth Section 70pD] of Olvislon 3 of the Business and Prafessions'Code, and my license is in full force and effect. SIGNATUREt • • bATe OWNER -BUILDER DECLARATION I hereby 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). CI 1, as owner of the property, or my employees with wages as their sole compensatlon, will do the work, and the structure is not intended or offered for sale. (Sec. 7044, Bussness and PrnfesaionR Code: The Contractor's Llcensa Law does not apply fo 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.) ❑ I, as owner of the property, am exclusively contracting with licensed contractors to con- struct the project. (Sec. 7044, Business and Pratessfons Code: The Contracfar'S Ckense 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. & P.C. for this reason Date owner WORKERS' COMPENSATION DECLARATION I hereby afrlrm 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 the permit is for one hundred dollars ($100) valuation w lass.) I Certify that In the performance of thg work for which this permit is issued, I shall not employ any Eurson in any manner so as to become subject to the Workers' Compensation Laws of California - Date Owner NOTICE TO APPLICANT: If, after makft this Eertfffcafe of Exemption you should become subject to the Workers' Compensallon provisions of the Labor Code, you must forthwith comply with such provisions or HIM 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 perftltt when properly filled out, signed and validated, and is subject to expiration it 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 Hof this city to enter tho above - mentioned property for inspection purposes. Signature of applicant Date Mailing Address — City, State, Zip No. ' 7 BUILDING: TYPE CONST. OCC. GRP. A.P. Number Legal Description Project Description Sq. Ft. No. No. Dw. Size Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation r. PERMIT r y AMOUNT Plan Chk. Dep. _Plan Chk. Bal. it t Const. �_ Mech. Y r Electrical 24.00 Plumbing 45.00 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: — Validated by: Validation: Date Permit 1ST I 2ND FOR GAR CAR WAL EST NO - VENT APPLI, FURN� AIR HI ABSOI COMPI H EATI BOI LE MAX. 1 PERMI DBL CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES, r- L SQ. FT. ® = L- SO. FT. ® SO. FT. @ SO. FT. ® P- SO FT ® SO FT. ® SQ. FT. MATED CONSTRUCTION VALUATION $ UNITS YARD SPKLR SYSTEM MOBILEHOMESVC. BAR SINK POWER OUTLET ROOF DRAINS DRAINAGE PIPING DRINKING FOUNTAIN URINAL $ WATER PIPING E- Not to be used as property tax valuation FLOOR DRAIN MECHANICAL FEES WATER SOFTENER ;YSTEM FAN EVAP.COOL HOOD (SIGN WASHER(AUTO)(DISH) ,NOE DRYER GARBAGE DISPOSAL GE UNIT WALL FLOOR SUSPENDED LAUNDRYTRAY NDLING UNIT CFM KITCHEN SINK FTIGN SYSTEM B.T.U. TEMP USE PERMIT SVC WATER CLOSET' IESSOR HP POLE, TEMIPERM LAVATORY IG SYSTEM FORCED GRAVITY AMPERES SERV ENT SHOWER I B.T.U. SO. FT. ® c BATH TUB SQ. FT. ® c WATER HEATER EATER OUTPUT, B.T.U. SO. Fr. RESID ® 11/4 c SEWAGE DISPOSAL SQ.FT.GAR @ 3/4c HOUSE SEWER GAS PIPING T FEE PERMIT FEE PERMIT FEE TOTAL FEES MICRO FEE MECH.FEE PL.CK.FEETNST. FEE ELECT. FEE SMI FEE PLUMB. FEE STRUCTURE ESSETBACK LAB GRADE FORMS FOUND. REINF. REINF• STEEL BOND BEAM Cn G d L p LUMBER GR. L FRAMING ROOFING VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATION/SOUND FINISH GRADING FIN�INSPECTION�2r [t! CERT. OCC. FENCE FINAL GARDEN WALL FINAL PLUMBING ELECTRICAL GROUND PLUMBING ikl�z/ UNDERGROUND ROUGH PLUMB. 1,112 SEWER OR SEPTIC TANK ROUGH WIRING GAS (ROUGH) 8 1 , / Q L METER LOOP GAS (FINAL) TEMP. POLE WATER HEATER SERVICE WATER SYSTEM FINAL INSP. FINAL INSP. 10(2(tCl(q/) C �tff 1612,ZI96) La 10130M C1 U, HEATING & AIR COND. SOLAR 4o A.C. UNIT COLL. AREA HEATING (ROUGH) STORAGE TANK DUCT WORK ROCK STORAGE HEATING (FINAL) OTHER APP.IEQUIP. FINAL INSP. G 2( GRADING ! / � cu. yd. $ plus x$ =$ REMARKS: