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05447 (PLBG)J r • �� P.O. BOX 1504 Building 78-105 CALLE ESTADO Address $9539 Gualaro LA QUINTA, CALIFORNIA 92253 Owner Wilhelm Mailing Address City Zip Tel. La {iairtre Lune No. Dw. Units Contractor^ ono Sealer Service Address P.0.. BOX 192 City Tel. Pam Desert Jzip 92261 6191346--2793.. State Lic. City & Classif. C42-480961 Lic. # 342 _ _ Arch., Engr., Designer Address Tel. City (Zip I State Lic. # LICENSED CONTRACTOR'S DECLARATION hereby affiml that I arrlicensed under provisions of Chapter 9 (commencing with Section 7000) of ivisi 1 3 of the Busi anforce, and Professions Code, and my is in full forcand effect �'" SIGNATURE 4 DATE -- OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason: (Sec. 7031.5,Busness and Professions Code: Any city or county which repuires a permit to construct, ager, irprove, demolish, or repair any structure, prior to its issuance also reprices the appOcant for such perm@ to We a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of Oivison 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 applicart to a cw® penally of not more than rive hundred dollars ($500). ❑ 1, 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 Prolassions Code: The Conbadoes 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 irprovements are not intended or offered for sale. If, however, the building or irprovenrent is said within one year of completion, the owner -builder will have the burden of proving that he dud 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 coatractor(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 hereby affirm that 1 have a cerfificete of consent to self -insure, or a(certificate of Workers Compensation Insurance, or a certifi copy thereof.*,(S®c. 3800, Labor Code.) Policy No company �. - 'rV i ...t.... ❑ Copy is filed with the city. ❑ Certified copy is hereby fumished. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars ($100) valuation or less.) I certify that in the performance of thg work for which this permit is issued, I shall not =any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date Owner NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become subject to' the workers' Compensation provisions of the Labor Code, you must forthwith comply with such provlsioru or this pemrit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code.) Lenders Name Lenders Address This is abuilding permit when properly filled out, signed and validated, and is subject to expiration if work thereunder is suspended for 180 days. I certify that I have read this application and state that the above information is correct. 1 agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives -of this city to enter the above-. mentioned property for inspection purposes. Signature of applicant Date Mailing Address City, State, Zip No. 05447 UILDING: TYPE CONST. OCC: GRP. .P. Number egal Description roject Description SEM 110OK WP REMARKS -6, `P tyf%:.$a?i^o-1?tia—�`t':k?,t�ijI:P ZONE: BY: Minimum Setback Distances: Front Setback from Center Line Sq. Ft. Size No. Stories No. Dw. Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ FINAL DATE INSPECTOR Issued by: Datef61Permit Validated by: Validation: Estimated Valuation $500. 000 PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. Const. Mech. Electrical Plumbing 20.00 S.M.I. Grading Driveway Enc. Infrastructure • r TOTAL REMARKS -6, `P tyf%:.$a?i^o-1?tia—�`t':k?,t�ijI:P 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: Datef61Permit Validated by: Validation: J CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES $ UNITS IST FL. SO. FT. ® YARD SPKLR SYSTEM 2ND FL. SQ. FT. MOBILEHOME SVC. BAR SINK POR. SO. FT. POWER OUTLET ROOF DRAINS GAR. SQ. FT. ® DRAINAGE PIPING CARP. SQ. FT. DRINKING FOUNTAIN WALL SQ. FT. URINAL SO. FT. @ WATER PIPING ESTIMATED CONSTRUCTION VALUATION $ NOTE: Not to be used as property tax valuation FLOOR DRAIN MECHANICAL FEES WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTOXDISH) APPLIANCE DRYER 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 SO. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SQ. FT. RESID ® 11/4 c SEWAGE DISPOSAL SQ.FT.GAR ® V/4c HOUSE SEWER GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEE 7 MECH.FEE PL.CK.FEE CONST. FEE ELECT. FEE SMI FEE PLUMB. FEE GTRUCTURC PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR SETBACK SLAB GRADE FORMS FOUND. REINF REINF. STEEL GROUT BOND BEAM LUMBER GR. FRAMING ROOFING VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATION/SOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCF FINAL GROUND PLUMBING ROUGH PLUMB. SEWER OR SEPTIC TANK GAS (ROUGH) GAS (FINAL) WATER HEATER WATER SYSTEM FINAL INSP. IUR'S SIGNA UNDERGROUND BONDING ROUGH WIRING METER LOOP TEMP.POLE SERVICE A.C. UNIT HEATING (ROUGH) DUCT WORK HEATING (FINAL) FINAL INSP. COLL. AREA STORAGETANK ROCKSTORAGE OTHER APPJEQUIP. GRADING FINAL INSP. cu. yd. $ plus x$ =$ REMARKS: GARDEN WALL FINAL