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14961 (BLCK)� I'4 P.O. BOX 1504 Building 51-5iO Ave. Obregon 78-495 CALLE TAMPICO Address LA QUINTA, CALIFORNIA 92253 Owner Es.et1uiel Coronet I maning Address P.O. "Box 1238 City Zip .' L Tel 92253 Quint r CA - 5z�4.454 Contractor Corosel. Construction 'City State Lic. & Classif. ; g 634981 Arch.- Engr., Designer Address No. 14561 BUILDING: TYPE CONST. OCC: GRP A.P. Number Legal Description Project Description 1251 of 51 high garden � block wall-. City Lic: # 2264 Sq. Ft. No. Size Stories No. Dw. Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition O NOTICE- TO APPLICANT: d, after making this Certificate of Exemption you: should become ZONE: BY: subject to the Workers' Compensation provisions of the Labor Code, you must forthwith City • Zip State Lic. # ' LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7}000) of.Divlslon 3 of the t3usiness and Professions Code, and my license is in full force and Front Setback from Rear Setback from SIGNATURE OWNER -BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractor's License Law for the following reason: (Sec. 7031.5,8uslness 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 licensedpursuant 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). O 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 wlthfn one year of completion, the owner -builder will have the burden of proving that he did not build or unprove 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 contractors) Otensed pursuant to the Contractor's License Law.) ❑ 1 am exempt under Sec. B. & P.C. for this reason Estimated Valuation .$2 '07.00 A" SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINESLIP TO ONE PERMIT _ - AMOUNT _ ' Plan Chk. Dep. _ Plan Chk. Bal. DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND Const. (ry4 Mech. - - Electrical 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. Plumbing fI S.M.I. ' Grading I agree to comply with all city and county ordinances and state laws relating to building. Driveway Enc. ` Date Owner Infrastructure mentioned property for Inspection purposes. Validated by: WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self -insure, or a certificate of Worker's Com nsation Insurance, or a certified copy thereof. (Sec. 3800. Labor Code.) Policy No Company ... opy 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 or less.) I certify that in the performance of the 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 Signature of applicant Date TOTAL 54.00 REMARKS City, State, Zip - ' NOTICE- TO APPLICANT: d, after making this Certificate of Exemption you: should become ZONE: BY: subject to the Workers' Compensation provisions of the Labor Code, you must forthwith Minimum Setback Distances: comply with such provisions or this permit shall be deemed revoked:- ' Front Setback from Rear Setback from WARNING: FAILURETO SECURE -WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND - Side Street Setback SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINESLIP TO ONE - HUNDRED.THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, Side Setback from DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. FINAL DATE S 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. fI I certify.that I. have read this application and state that the.above information is'correct. Issued by: Date l 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. Validated by: Signature of applicant Date Mailing Address Validation: City, State, Zip e CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBIW FEES • 1ST FL. SO. FT. ® $ UNITS SLAB GRADE ROUGH PLUMB. BONDING YARD SPKLR SYSTEM 2ND FL. SO. FT. FORMS SEWER OR SEPTIC TANK ROUGH WIRING MOBILEHOME SVC. BAR SINK POR. SO. FT. ® GAS (ROUGH) . METER LOOP GAR. SO. FT. ® POWER OUTLET ROOF DRAINS GAS (FINAL) TEMP. POLE DRAINAGE PIPING CAR P. SO. FT. GROUT WATER HEATER WALL SO. FT. FINAL INSP. DRINKING FOUNTAIN. SO. FT. ® WATER SYSTEM URINAL ESTIMATED CONSTRUCTION VALUATION $ =$ WATER PIPING NOTE: Not to be used as property tax valuation FINAL INSP. FLOOR DRAIN MECHANICAL FEES WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASH ER(AUTO)(DISH) APPLIANCE DRYER GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED LAUNDRYTRAY AIR HANDLING UNIT CFM FIRE ZONE ROOFING ' 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. SO. FT. ® c BATH TUB LATHING SO. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 1+/a c SEWAGE DISPOSAL SO.FT.GAR ® 3/ec HOUSE SEWER GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE DBL TOTAL FEES i 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. GAS (ROUGH) . METER LOOP HEATING (FINAL) OTHER APP./EOUIP. REINF. STEEL GAS (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM 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 INSULATION/SOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIONATURESIINITIALS GARDEN WALL FINAL N . • ... � � �- �Q I cv �1 ne �� 5 � 5 �44.�1 ��a �,-�� dr,'� � r Y 1� - -y CITY OF L OUNBUILDING 1 '� ______._ ..._— • �,..orr.:..y.......�......�,....Q.wa'eru Af PLI •ABLE OWES �� ( �►t7'Q►ir! ' 57 / — r t} -- .DATE C37 1 r d i I ' -A gad t -- -_ -'" • i acl 0 � r. _._. i r • '� , f'�? 2. r � I dirt 1' b