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15353 (PLBG)4 Building Address 78-641 Highway 111. Address SaMe cgs above City Zip Ufa Quiw6a 92253 Contractor i Scott P. $sell Address _ La Quinti State Lic. & Classif.. 670.038 Arch., Engr., Designer Address City f '.'. LICENSI Jhereby affirm that I am license „7000) of Division 3 of the,Bus`ine: c&tyl • - P.O. BOX 1504 t' No. 15353, 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING: TYPE CONST: OCC. GRP. A.P. Number. Tel. 564-5455 Legal Description Project Description Move existing plumbing to n6w cabinet. location, add 110v 24 amp circuit' 92253 - 564-0088 City j� Lic. # 7 ?0 Tel. Zip State LIC. # CONTRACTOR'S DECLARATION under4rovisions of Chapter 9 (commencing with Section a Professions Code, and my li nse in f II force and OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason: (Sec. 7031.5,Susiness and Professions Code: Any city or county which requires a 9x self con'tained' X- Ray machine, and change doter ©peeing. Sq. Ft. No. No. Dw. Size Stories Units New ❑ Add ❑ Alter%© Repair ❑ Demolition ❑ r . k i Estimated Valuation • $2,600.00 Permit to construct, after, improve, demolish, or repair any structure, prior to its issuance also requires the applicant for such permit to fire a signed statement that he is licensed pursuant to the provisions or 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 fire 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 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 o! completion, the owner -builder will have the burden or proving that he did not build or improve for the purpose. of sale.) PERMIT AMOUNT , Plan Chk. Dep. Plan Chk. Bal. Const. Mech. Electrical 30.0 ` Plumbing • b. 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 contractors) licensed pursuant to the Contractor's License Law.) ❑ I am exempt under Sec B. t: P.C. for this reason r S.M.I. _.. Grading Driveway Enc. Date owner Infrastructure WORKERS' COMPENSATION DECLARATION WorkeI hereby'affirm'that I have a certificate of consent to self -insure, or a certificate of r's Compensation Insurance, or a certified copy.thereof. (Sec. 3800, Labor Code.) . Policy No. Company O Copy is filed with the city. ❑ Certified copy is hereby furnished. TOTAL • CERTIFICATE OF EXEMPTION FROM • WORKERS'COMPENSATIONINSURANCE REMARKS (This section need not be completed it the permit Is for one hundred dollars ($100) valuation or less.) ' .,++�� I certify that in the performance of thg work for which t is pert2iit is issued, I shall not �employ,any,pperson; in.any manner o as to become subject to the Workers' Com nsation, Laws 'f Califdmia�• Da i1 _�% f ,Owner NOTICE TO APPLICANT:. ti, after making- this Certificate of Exemption you should become NOTICE. TO subject Workers' Compensation provisions of 'the Labor Code, you .must forthwith comply with such provisions or this permit shall be deemed revoked. ZONE: BY: Minimum Setback Distances: Front Setback from Center Line WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT.AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOR CODE, INTEREST, AND Rear Setback from Rear'Prop. Line Side Street Setback•from Center Line Side Setback from Pfop rty LinerL�� ATTORNEY'S FEES. This is a building permit when properly filled out, signed and validated, and is subjectto expiration it work thereunder is suspended for 180 days. I certify that l 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. FINAL DATE IN PECT�I�R I A' ISSUed by: Date'�Permit r V '7 ^ Validated by: Signature of applicant Date Mailing Address Validation: l City, .State, Zip CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBINU FEES 1ST FL. SQ. FT. ® $ UNITS COLL. AREA 2ND FL. SQ. FT. ROUGH PLUMB. YARD SPKLR SYSTEM POR. SO. FT. ® MOBILEHOME SVC. BAR SINK GAR. SQ. FT. ® POWER OUTLET ROOF DRAINS CAR P. SQ. FT. DUCT WORK DRAINAGE PIPING WALL S0. FT. ® GAS (ROUGH) DRINKING FOU FOUNTAIN _ SQ. FT. ® HEATING (FINAL) URINAL ESTIMATED CONSTRUCTION VALUATION $ GAS (FINAL) WATER PIPIN NOTE: Not to be used as property tax valuation FLOOR DRAIN MECHANICAL FEES WATER HEATER WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASH ER(AUTO)(DISH) APPLIANCE DRYER WATER SYSTEM GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED GRADING cu. yd. plus x$ LAUNDRYTRAY AIR HANDLING UNIT CFM 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 SQ. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 11/4 c SEWAGE DISPOSAL SQ.FT.GAR ® 3/4c HOUSE SEWER GAR. FIREWALL 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 ROCKSTORAGE FOUND. REINF. GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APP.IEOUIP. REINF. STEEL GAS (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE iFINAL INSP. BOND BEAM WATER SYSTEM $ GRADING cu. yd. plus x$ =$ LUMBER GR. FINAL INSP. FRAMING FINAL INSP. ROOFING ,'I a �� /��' • _' REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING ZfZ MESH INSULATION/SOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESJINITIALS GARDEN WALL FINAL :7]