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05730 (BLCK)Building 7,9,,,91( UMM011 Owner D014 HDXM Mailing Address 79--$I3 COEIIIi`RY CLUB Ci BtkNUDA DIMES Zip92201 • int- 6 L. � ,.. Address SAM City State Lic. & Classif. Arch., Engr., Designer Address City ucFllsEo I hereby affirm that 1 am licensed 7000) 0% bivi'sion 3 of the Business; i4 P.O. BOX 1504 No. 05730 78-105 CALLE ESTADO LA QUINTA, CALIFORNIA 92253 BUILDING: TYPE CONST. OCC: GRP. ~. A.P. Number 617--121--023 Tela City Lic. # State Lic. # DECLARATION Df Chapter 9 (comrr)encing v ode, and my license is in fL Section irce and OWNER -BUILDER DECLARATION l.hereby affirm that 1 am exempt from the Contractor's License Law for the following reason:. (Sec. 7031.5,13usirress and Professions Code: Any city or county which requires a Permit . to construct, after, kwmve, demolish, or repair any structure, prior to its issuance also requires the applicant for such permit to hie a signed statement that he is licensed pursuant to the provisions of the Contractor's License taw, Chapter 9 (commencing with Section 7000) of DWsfon 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 civilpenally olnot more than five 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 Contractors License Law does not apply to an owner of property who builds or 'reproves 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 inproverent is soil within one year of completion, the owner -builder will have the burden of proving that he did not build o 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 bulls or mproves 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 ff 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 alifornia- DateOwner NOTICE TO APPLICANT. h after ma" this Certificate of Exemption you should become subject to the Nbrkers' Compensation provisions of the Labor Code, you must forthwith comply wfth such provisions or this 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 permit when properly filled out, signed and validated, and is subject to expiration it work thereunder is suspended for 180 days. I certify that 1 have read this application and state that the above information is correct. 1 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 Legal Description Project Description 6 -FM AOCK WALL w 70 P Sq. Ft. No. No. Dw. Size Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation $1,750.00 r PERMIT R AMOUNT Plan Chk. Dep. Distances: Plan Chk. Bal. Front Setback from Center Line Const. 45.00 Mech. Side Street Setback from Center Line Electrical Side Setback from Property Line Plumbing FINAL DATE S.M.I. .I Grading Issued by: Driveway Enc. ^ Infrastructure Validation: A — TOTAL A/ `,,, REMARKS jt.K}r�6 Pn'f K1-607: t: i 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 3/11%89 Issued by: Date Permit Validated by: Validation: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING '= ' IST FL. SQ. FT. ® $ UNITS COLL. AREA SLAB GRADE YARD SPKLR SYSTEM 2ND FL SQ. FT. HEATING (ROUGH) STORAGE TANK FORMS MOBILEHOME SVC. BAR SINK POR. SQ. FT. ® DUCT WORK ROCK STORAGE GAR. SQ. FT. ® POWER OUTLET ROOF DRAINS METER LOOP HEATING (FINAL) DRAINAGE PIPING CARP. SQ. FT. GAS (FINAL) WALL SQ. FT. DRINKING FOUNTAIN. SOFT ® URINAL ESTIMATED CONSTRUCTION VALUATION $ FINAL INSP. WATER PIPING NOTE: Not to be used as property tax valuation FLOOR DRAIN MECHANICAL FEES GRADING cu. yd. $ plus x$ WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER FINAL INSP. GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED LAUNDRYTRAY AIR HANDLING UNIT CFM KITCHEN SINK ABSORPTION SYSTEM B.T.U. TEMP USE PERMIT SVC WATER CLOSET' COMPRESSOR HP POLE, TEM/PERM LAVATORY HEATING SYSTEM FORCED GRAVITY AMPERES SERV ENT SHOWER BOILER B.T.U. SQ. FT. ® c BATH TUB SQ. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SQ. FT. RESID ® 1+/4 c SEWAGE DISPOSAL SQ.FT.GAR ® 3/sc HOUSE SEWER GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEE MECH.FEE PL.CK.FEE CONST. FEE ELECT. FEE SMI FEE PLUMB. FEE STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR SETBACK GROUND PLUMBING UNDERGROUND A.C. UNIT COLL. AREA SLAB GRADE ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMS SEWER OR SEPTIC TANK ROUGH WIRING DUCT WORK ROCK STORAGE FOUND. REINF. /po �Q AS (ROUGH) METER LOOP HEATING (FINAL) OTHER APPJEQUIP. REINF. STEEL GAS (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM S WATER SYSTEM GRADING cu. yd. $ plus x$ =$ LUMBER GR. FINAL INSP. FRAMING FINAL INSP. ROOFING REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATIONISOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS ' GARDEN WALL FINAL I