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09083 (SIGN)Building Address 78-411 HWT. 1 i i Owner SIM©R MOTORS Mailing Address City Contractor Address Zip State Lic. . & Classif. 315204 C-45 Arch., Engr., Designer N/A n Address P.O. BOX 1504 N o. 78-105 CALLE ESTADO LA QUINTA, CALIFORNIA 92253 BUILDING: ­TYPE CONST. 1W - STOC: GRP A. -P. Number Tel. 546_2345 Legal Description Project Description T.1te.1RTrTJ S:Rl;14 ICS Tela 619-588-2092 City Lic. # Sq. Ft. No. No.'Dw. , Size Stories Units Tel. New ❑ Add ❑ Alter ❑ Repair ❑ - Demolition ❑ Date Owner 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.) Policy No. .Company 0 Copy 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 thg 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:. It, alter making this Certificate of Exemption you should become subject to the Workers' Compensation provisions of the Labor 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 Address City, Slate, Zip ' •� Y r._,.� .. Y ,,e a •i Infrastructure TOTAL $63.28 REMARKS AMOUNT .63.00 M951912 V1, 8831-12.6.27w9t. - - .) X Lam" o f l; 1 05, l;i ZONE: BY: Minimum Setback Distances: City Zip State Rear Setback from Rear Prop. Line Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed. under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. /�yy r� INSPECTOR 'R� SIGNATURE Nk:,/' f "' DATE Validated by: OWN ER- BUILOE 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, 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 thathe is exempt therefrom, and the basis .tor the allegedezemption. Any violation o/ Section 7031.5 Dy 'any applicant for a permit "r the the "can,to a civil penalty o/ not more than live hundred dollars (5500). ' ' ;: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 Code: The Contractor's License Law does not apply to an owner of property who -'builds Estimated Valuation ' PERMIT ' Plan Chk. Dep. Plan Chk. Bal. Const. 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 Mech. 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 o/ sale.) Electrical ❑ I, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing 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.1. such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) ❑ I am exempt under Sec. B. & P.C. for this reason Grading Driveway Enc Date Owner 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.) Policy No. .Company 0 Copy 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 thg 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:. It, alter making this Certificate of Exemption you should become subject to the Workers' Compensation provisions of the Labor 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 Address City, Slate, Zip ' •� Y r._,.� .. Y ,,e a •i Infrastructure TOTAL $63.28 REMARKS AMOUNT .63.00 M951912 V1, 8831-12.6.27w9t. - - .) X Lam" o f l; 1 05, l;i 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: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES IST FL. SO. FT. ® $ 2ND FL. SQ. FT. POR. SO. FT. ® GAR. SO. FT. ® CAR P. SQ. FT. ® WALL SO. FT. ® SQ FT ® ESTIMATED CONSTRUCTION VALUATION $ UNITS MOBILEHOME SVC. POWER OUTLET YARD SPKLR SYSTEM BAR SINK ROOF DRAINS DRAINAGE PIPING DRINKING FOUNTAIN URINAL WAIER PIPING NOTE: Not to be used as property tax valuation ROUGH PLUMB. FLOOR DRAIN MECHANICAL FEES HEATING (ROUGH) WATER SOFTENER VENT SYSTEM FAN EVAP.000L HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER ROCK STORAGE GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED LAUNDRY TRAY AIR HANDLING UNIT CFM OTHER APPJEOUIP. 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 WATER SYSTEM SQ. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SQ. FT. RESID ® 1+/4 c SEWAGE DISPOSAL SO.FT.GAR ® 3/ic HOUSE SEWER FINAL INSP. 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 REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATION/SOUND FINISH GRADING FINAL INSPECTION 3 CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURES/INITIALS GARDEN WALL FINAL