Alta Verde - Pasa Tiempo TR 34243 (Plans 1-3) Revision 1V,%/ 11/ LVVv UIVI� iJ, L: I 1•AA � � V �.•rvva., v
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$..L,�. �$ P0.13ox y5oa APPLICATION ONLY
l3uiIdir7g ) 78-495 CALLE TAMPICO
Address Ll/,l�L> Of If'YZO�d-�rbo Gj-{-, LA QUINTA, CALIFORNIA 92253
Owner F
DL 27 co -rnn/'i BUILDING: TYPE CONST. OCC. GRP.
Mailing `��
Address tooIV f W A.P. Number
Z' 'vaW��igal'Description
Contractor oject Description �l DL/YVt. �I.I
Address l
Ire t Lo
a. Ply�f-
City Zip Tel.
State Lic. City S Ft. No. 1 No. Dw.
& Classif. Lic. # Size Stories I Units
Arch., Engr.;
Designer ����^ ' fin• `I
Address Tel.
1AV? 5Tre� 01 66) -t9/
City Zip State
G�acr, t�i 0 �24 a Uo. #Gl'1
CENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Seclion
700D) of'Division 3 of the Business and Prolesslons Code, and my license is in full force a
ffect.
NATURE
OWNER43UILDER DECLARATION,
hereby affirm that I am exempt from the Contractor's Ucense Law for the f owing
reas : (Sec. 7031.5, Business and Professions Co.,..Arry city or county which uIres a
per construct, alfe r improve, demolish, or repair any structure, prior to Its ! nce also
teQulre applicant for such permit to qle a signed statement that he is license ursuant to
the prov ns of the Confracfors License Cax Chapter9 (commencingg with S on 7000) of
DlwsIon the Business end Professions Code, or that he Is exempt Iherelro nd the basis
forihoalle exemption. Any violation ofSection 7031.5byany applicant for ermirsubjects
the applican a civil penalty of not more than five hundred dollars (S500).
O 1, as owner a property, or mY employees with wages as their sole a pensation, will do
the work, and M ructure Is not Intended or otlerW for sate. (Sec. 7044 siness and Profes-
sions Code: The racror's License Law does not apply to an owner property who builds
or improves there d who does such work himself or through his empbyaes, provided
that such Improvem are not Intended or offered for sale. ff, fro ver, the building or im-
provement is sold wi one year of completion, the owner -bull wI f have the burden of
proving that he did not ' d or Improve for the the
of sale).
O 1, as owner of the pro ern exclusively contracting with I d contractors to construct
the project. (Sec. > , B ass and Professions Code: Th onfractor's License Law does
not apply to an owner of pro who builds or Improves on, and who contracts for such
projecfs with a contractor(s) fi sad pursuant to the Con for's License Law.)
O 1 am exempt under Sec. B. ti P.C. forth' eason
Date owner
WORKER'S CO NS N DECLARATION
I hereby affirm that I have a certificate sent to sell -Insure, or a certificate of workoes
Compensation Insurance, of a cenlfled co reoL (Sec. 3800, Labor Code.)
Policy No. Company
O Copy Is tiled with the city. O Ce ' d co Is hereby furnished.
CERTIFIC OF EXE ION FROM
WORKERS' MPENSATI NSURANCE
(This section need not be eomplet if the permit Is ! e hundred dollars (5100) valuation
or less).
I certify lhat In the. perfor ce of the work for wh his ppermlt is Issued. I shall not
employ any person In any man so as to become sutr(ecl t i' orkers' Compensation Laws of
California.
Date Owner
'NOTICE TO APPLICANT: after making this Certificate of t:xe Ion you should become -
1 subject to the Workers' .ompensaflon Provisions of the Labo Lde, you must forthwith
comply with such prov ns or this permit shell be deemed revoke .
CONSTRUCTION LENDING -AGENCY
/all.ingAddr6ss
ereby afff that there Isla construction lending agency /or the pert of
,. ich this p It Is issued. (Sec. 3097, Civil Code.) ,
ti r's Na
r's A ass ..is i building permit when property filled out, signed end validated, and Islio work (hereunder Is suspended for 180 tlays.
fy that I have read this application and state that the above information is
o comply withall city and county ordinances and stale taws relatingtolion, and hereby authorize representatives of this city to enter the.aboventh
lot inspection purposes.ure of applicantDate Addresslate, Zip'
WHITE = BUILDING DEPARTMENT
New) . Add O Alter O Repair O Demolition O
06 20� .
3 3 9 asp
y.
W:YiYfllziLii4�MiSTM K", • iw
_11W 'WIVV N,1
_M5
_011T/��POm
Grading r
• WT_ J
11.
ZONE:
B
—
Minimum Setback Distances:
Front Setback from Center Line
"k
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
to -
Side Setback from Property.Line
a
FINAL DATE
INSPECTOR
igd
Issued by:
Date Permit
_
Validated by:'
_
Validation:_
YELLOW = APPLICANT
y �pINK F N NCE4 " t