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9435 (BLCK)4'4 P.O. BOX 1504 N o . 9435 54-370. Obregon' - 78-105 CALLE ESTADO LA QUINTA' CALIFORNIA 92253 y Yanez 5 —37€i-Obragon Zip Tel. 92253 5 uinta BUILDING: TYPE CONST.OCC: GRP. A.P. Number tgal Descriptionoject Description 40' fl =5''..:bZE3 's wall .iJ' Py n- U4. 251 of 3 1 bi ock wall wall We), Sq. Ft. No. No. Dw. Size Stories Units Designer New ❑ Add ❑ Alter ❑ Address Tel. - 111 lljfjjj,��r City Zip State ' Lic. # WORKERS' COMPENSATION;DECLARATION LICENSED CONTRACTOR'S 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.) :rw I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section ` ;1 7000) of Division 3 of the Business and Professions Code, and my license is in full force and t effect. • ❑ Copy is filed with the city. ❑ Certified copy is hereby furnished. SIGNATURE DATE OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason: (Sec. 7031.5,Business 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 81e a signed statement that he is licensed pursuant to, the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) or Division 3 or 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).' I as owner of the property, or my employees with wages as their sole compensation, will " _ 0 Estimated Valuation - PERMIT Plan Chk. Dep. Plan Chk. Bal: COr1st. he 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 of completion, the owner -builder will have the burden of proving that he did not build or Improve for the purpose of sale.) 'Mach. Electrical Plumbing ❑ 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 S•M.1. ' does not apply to an owner or property who builds or Improves thereon, and who contracts for such projects with a contractor(s) icensed pbrsu'ant to the Contractor's License Law) Repair ❑ Demolition ❑ 344.08 AMOUNT Z.> 4 U U ❑ I am exempt under Sec.af! �r8. & P.C. for this reason Grading - 111 lljfjjj,��r Driveway Enc. Date Owne ;� ��i �'�'`�� Infrastructure 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.) t _ Policy No. Company • ❑ Copy is filed with the city. ❑ Certified copy is hereby furnished. TOTAL D U CERTIFICATE OF EXEMPTION FROM l` WORKERS' COMPENSATION INSURANCE REMARKS (This section need not be completed !e permit is for one hundred dollars ($100) valuation _ h or less.) c I certify that in the performance f�4hf work for which this permit is issued, I shall not S „.,a ;�, t a ..� "`$.-' 1 SJ 1 C7,3, I g� a aQ employ any person in any manner�so as to become subject to the Workers' Compensation' Laws of California. 1 1/ Date ' t'+ f ry �W'7 O Ownl;��\ ` NOTICE TO APPLICANT: 14 ager making this? Certilicate o/ Exemption you should become - ZONE:' BY: - - •' subject' to the Workers'i mpensation provls`lons o' � the Labor Code, *you .must. forlhwirn - comply with such provisions nor permit shall tie deemedrevoked./ Minimum Setback Distances: - 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 I have read this application and state that the above information is correct. I agree to comply with ell 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 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: Date Permit" Validated by: ' Validation: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SO. FT. ® $ 2ND FL. SQ. FT. POR. SQ. FT. ® GAR. SQ. FT. ® CARP. SQ. FT. WALL SQ. FT. ® SQ FT ® ESTIMATED CONSTRUCTION VALUATION $ UNITS MOBILEHOME SVC. POWER OUTLET YARD SPKLR SYSTEM BAR SINK ROOF DRAINS DRAINAGE PIPING DRINKING FOUNTAIN. URINAL WATER PIPING NOTE: Not to be used as property tax valuation SLAB GRADE FLOOR DRAIN MECHANICAL FEES WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER ROUGH WIRING. GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED DUCT WORK LAUNDRY TRAY AIR HANDLING UNIT CFM GAS (ROUGH) 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 WATER HEATER SQ. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SQ. FT. RESID ® 11/4 c SEWAGE DISPOSAL BOND BEAM SQ.FT.GAR @ V4c 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. GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APPJEOUIP. 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 q � / ,I REMARKS: VENTILATION FIRE ZONE ROOFING' FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATION/SOUND FINISH GRADING FINAL INSPECTION - CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL