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003397 (ELEC)4 P.O. BOX 1504 N o . Building 78-105 CALLE ESTADO Address 49-407 GUIJARRD LA OUINTA, CALIFORNIA 92253 Owner DOW SPENGM 003397 Mailing" BUILDING: TYPE CONST. OCC..GRP. Address A.P. Number LA QM"A COM&Y CUB City Zip Tel. LA QU A 92253 • 1 Legal Description G & W 10M POOL PLUMBING (ALL AMERICAN POOLS) Address .. 73-725 EL PASSO #23C City Zip - Tela " PAM DFUTMT 92260 340-3447 State Lic. City & Classif. 404640 Lic. # 816 Arch.,- Erigr., Designer Address Tel. City Zip State Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that l:am'Iicensed under provi9l-6ns'of°Cha0tep9 (commencing with Section 70(X) of Division 3 of°the?Business and:Professions Code; and my license is in full force and effect.` d OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractors Licensa Law for the following reason: (Sec. 7031.5,8usiness and Professions Code: Any city or"county which requires,, a permit to construct, after, 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, aAd 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). ❑ 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 Contractor's License Law does not apply to 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 or 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 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 . O Copy is filed with the city. O 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 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 NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become subject' to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. Project Description LIGHT WiCAPSMATION Sq. Ft. No. No. Dw. Size Stories, Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ CONSTRUCTION LENDING AGENCY stimated Valuation fl•Ow PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. Lender's Name Const. Mech. DATE Electrical 20.00 Plumbing S.M.I. Grading I certify that I have read this application and state that the above information is correct. Driveway Enc. Date 9129187 Permit Infrastructure construction, and hereby authorize representatives -of this city to enter the above- mentioned property for inspection purposes. Validated by: Signature of applicant Date TOTAL REMARKS Validation: ry.V r}. r;w ,� C�•�}��j� � / tt i 1311. 13i x - ZONE: BY: Minimum Setback Distances: Front Setback from Center Line Rear Setback from Rear Prop. Line CONSTRUCTION LENDING AGENCY Side Street Setback from Center Line 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.) Side Setback from Property Line Lender's Name Lender's AddressFINAL DATE INSPECTOR 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. Issued by: Date 9129187 Permit 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. 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