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9963 (PLBG) IIIIIII VIII III VIII IIII 37 IE — - -- P.O. BOX 1504 No. 9963 Building 49-802 AVILA LA Q 7&105 CALLE ESTADO Address UINTA,CALIFORNIA 92253 0J Owner WELTON BUILDING: TYPE CONST. Mailing OCC:GRP. Address SAME A.P.Number City Zip Tel. LA QUIN`1'A Legal Description Contractor R EC©NO SEWER Project Description SEWER HOOKUP- Address P 0 BOX 192 City Zip Tel.: Aalm desert State Lic. City &Classif. 480951 Lic.# 342 Sq.Ft. No. No. Dw. Arch., Engr., Size Stories Units Designer New ❑ Add ❑ Alter ❑ Repair❑ Demolition ❑ Address Tel. City Zip State Lic.# LICENSED-CONTtRACTOR'S DECLARATION �w �- I hereby affirm that I am icen�edi under-provisions of Chapter 9(commencing with-Section 7000)of Division 3 of t e`Business and Professions Code;-and my license is in-full force d, effect_ �'_ �, C_ `•"l7 f % F /f�%/ SIGNATURE --_ - 'F, f t! "rr / DATE OWNER-BUILDER DECLARATION Estimated Valuation I hereby affirm that I am exempt from the Contractor's License Law for the following $1500 reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a Permit to construct, atter, improve, demolish, or repair any structure, prior to its issuance also AMOUNT requires the applicant for such permit to file a signed statement that he is licensed pursuant to PERMIT 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 Plan Chk. Dep. - subjects the applicant to a civil penally of not more than rive hundred dollars(8500). ❑I,as owner of the property,or my employees with wages as their sole compensation,will Plan Chk. Bal. do the work,and the structure is not intended or offered for sale.(Sec. 7044,Buisness and Const. 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, Mech. 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 Electrical of proving that he did not build or Improve for the purpose of sale.) ❑1,as owner of the property,am exclusively contracting with licensed contractors to con- Plumbing :`13u.UU 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 S.M.I. - such projects with a contractor(s)licensed pursuant to the Contractor's License Law.) Grading ❑I am exempt under Sec. B.ti P.C.for this reason Driveway Enc. Date owner Infrastructure WORKERS'COMPENSATION DECLARATION AnIZ 4 0h 4P, A-00!t AP—)7_04 40 I hereby affirm that I have a certificate of consent to self-insure,or a certificate of - ANK )IJ StQJ Worker's'Compensation Insurance,or a certifiegdd Copy thereof.�(Se 3800,Labor Code.) olicyNo.i Company Vi:3.)JL�Y klacsY.ri ]Copy is filed with the city. ❑Certified copy is hereby furnished. TOTAL *30.00 CERTIFICATE OF EXEMPTION FROM REMARKS 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 NOTICE TO APPLICANT. If, after making this Certificate of Exemption you should become ZONE: BY: subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. 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 Address This is a building permit when properly filled out,signed and validated,and is subject to FINAL DATE INSPECTOR expiration if work thereunder is suspended for 180 tlays. I certity that 1 have read this application and state that the above information is Correct. Issued by: Date 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. Validated by: Signature of applicant Date- Mailing Address Validation: City, State, Zip CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SQ.FT.® $ UNITS 2ND FL. SQ.FT. YARD SPKLR SYSTEM POR. SQ.FT.® MOBILEHOME SVC. BAR SINK GAR. SQ.FT.® POWER OUTLET ROOF DRAINS CAR P. SQ.FT. DRAINAGE PIPING WALL SQ.FT. DRINKING FOUNTAIN SQ FT ® URINAL ESTIMATED CONSTRUCTION VALUATION $ WATER PIPING NOTE:Not to be used as property tax valuation FLOOR DRAIN MECHANICAL FEES WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) 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,TEMIPERM 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®VAc 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 FORMSOf W SEWER OR SEPTIC TANK�C C11 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 LUMBER GR. FINAL INSP. cu.yd. FRAMING FINAL INSP. $ Plus-x$_=$ ROOFING REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATION/SOUND FINISH GRADING FINAL INSPECTION 7 CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURES/INITIALS GARDEN WALL FINAL