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11919 (PLBG)t �. 4 QUA& P.O. BOX 1504 Building 78-105 CALLE ESTADO Address 54-580 Carranza LA QUINTA, CALIFORNIA 92253 Owner Scott Bossart Address Sate City I Zip Tel. La Quinta, CA 92253\ Contractor RVS Plumbing/Rick Stevenson Address 74110 Velardo CitPaylm Desertp Or Ip 92260 State Lic. & Classif. 602396 C36 Arch., Engr., Designer Address 341-•9224 City Lic. # 2323 Tel. City IZIp I State L}}LENSED CONTRACTOR'S DECLARATION I hereby ofi m t wt�harytlicensed unQer g1ovi :ons Chapter 9 (commencing with Section X00) of, (vision � fi ; _us_ir�S�a7a" Pro e_ oqs,- de,?andirrly license is in full force and 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, alter, 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, 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 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 of completion, the owner -builder will have the burden of proving that he did not build or improve for the purpose of sale.) O 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 :o self -insure, or a certificate of Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.) Policy No. .Company ❑ Copy is filed with the city. ❑ Certified copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM/E WORKERS' COMPENSATION INSURAr�EE (This section need not be completed i/ thegpeo,. is' for on"e. hundred dolla(.S 100) valuation or less.) !! I certify that in the pert rmo ance of thk fof whichtta•sfpe�ns sued¢( shall not employ any person in ahy manner so as t9fn� subje tfto they ke"fs' C npensation Laws of California. %1' f ,, (J: k Lf ! !! II' ..5 �/' uac vw er i !A FI NOTIOE TO APP ICA Ifafter,rr1"' CeTtl(icaleAbf Exempt jou shouT ome subject to the Woi4ts:'Compensation provisions olLabor Code, you must forthwith comply with such provisions or this permit 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.) Lender's Name Lender's Address 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. 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. Signature of applicant -Date- Mailing ateMailing Address City, State, Zip No. 11919 BUILDING: TYPE CONST. OCC. GRP. A.P. Number Legal Description Project Description Sewer Connect ZONE: BY: Minimum Setback Distances: Front Setback from Center Line Sq. Ft. Size No. Stories No. Dw. Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Side Setback from Property Line FINAL DATE INSPECTOR Issued by: Date Permit Validated by: Validation: Estimated Valuation $1,,300.00 PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. Const. Mech.% 30.00 Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure IV" -`t.AS'ff 1 ff11AL' TOTAL 30.00 REMARKS 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: Date Permit Validated by: Validation: '7 CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SO. FT. ® $ UNITS SLAB GRADE a BONDING YARD SPKLR SYSTEM 2ND FL. SO. FT. @ FORMS SEWER UGH 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 FRAMING FLOOR DRAIN MECHANICAL FEES WATER SOFTENER VENT SYSTEM FAN EVAP.000L HOOD SIGN WASH ER(AUTO)(DISH) APPLIANCE DRYER GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED LAUNDRYTRAY AIR HANDLING UNIT CFM I 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. SO. FT. ® c BATH TUB SO. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 11/4 c SEWAGE DISPOSAL INSULATION/SOUND SO.FT.GAR ® 3/4c HOUSE SEWER FINISH GRADING GAS PIPING PERMIT FEE FINAL INSPECTION 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 UGH WIRING DUCT WORK ROCK STORAGE FOUND. REINF. GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APP.IEOUIP. 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 SIGNATURESIINITIALS GARDEN WALL FINAL Receive( Address Account Service j ❑ Meter(s) ❑ Service(s) ❑ Backflow(s) ❑ House lateral(s) ❑ Detector Check(s) ❑ Meter Surcharge Sanitation Capacity Charge ❑ W.S.B.F.C. ❑ Temporary Construction Meter ❑ Turn on Charge ❑ Uncollected Account - Name ❑ Inspection Fee - Tract - Fee - O Plan Check Fees Water / Sewer - Tract - ' O Bond Payment - A.D. - Bond Assmt. ❑ Customer Deposit ❑ Other N2 "* 41.492 Remarks: ❑Copy to: Cash Check Money Order t r Water Service -. Cashier -438(11189)