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15666 (SIGN)t Building Address Owner P.O. BOX 1504 N O . 15666 78--95#J Hwy ill Wal-Mart Stores, YAC 10-495 CALLS TAMPICO LA OUINTA, CALIFORNIA 92253 Mailing Address P. 0. $©x ii CityZip Tel. Bentonville, ;X: 72716-80 D1 (501) 277449 Contractor Qt, iel Bros. S�gn Co. Address 272 South 010 Street fan Bernaidino Zip 92410 State Lic. . & Classif.. .M/C.10 217345 Arch., Engr., Designer Address Tei9Q9) 885-4476 Lic. # 3830 Tel. City ( Zip ( State Lic. # war LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am gen ; under provisions of Chapter 9 (commencing with Sectic 7000) of Division 3 off in s and P?ofe'ssions Code, and my license is�in full fgrcg an effect. - �f'' l� Ai A ti� .�J,, k^" �Y5 "� OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the contractors License Law for the following reason: (Sec..7031.5,Susiness 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 rile 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'reprove for the purpose or sale.) ❑ 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) (rcensed pursuant to the Contractor's License Law.) ❑ 1 am exempt under Sec. t�B. & P.C. for this reason. r Date Owner WORKERS' COMPENSATION DECLARATION. I hereby affirm that 1 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.) Polic;1 Company `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 (S100) valuation or less.) I certify that In the performance of thg work for whic(� this permit is issued, I shall not employ any person i any manner.so aeleo become subject to the Workers' Compensation Laws of California Date it Ownerr'4 A� ."`".sw NOTICE TO APPLICANT: If, alter making" this {{"Ce•rtihcate of Exemption you should become subject to the Workers' Compensation provissrdns of the labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. 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 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. This is a building permit when properly filled out, signed and validated, and is subject to expiration it work thereunder is suspended for 160 days. I certify that I have read this application and state that the above information is correct. I agree tocomply 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, State, Zip LDING: TYPE CONST. OCC: GRP. P. Number Description Sign t Description Sq. Ft. No.' No. Dw. Size Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation $800.00 PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. Const. Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure Sin 30.00 TOTAL 30.00 REMARKS ZONE: BY: Minimum"Setback Distances: Front Setback from Center Line Rear Setback fro `Rea "Prop. Line Side Street //Setback from -Center Line Side S ibaek from Property, Line, FINAL DATE Rr INSPECTOJJR �s Issued by: D e )Permit /1 Validated bv: Validation: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBINU FEES y IST FL. SO. FT. @ $ UNITS SLAB GRADE ~ 2ND FL. S0. FT. @ BONDING YARD SPKLR SYSTEM POR, 1 SO. FT. @ MOBILEHOME SVC. BAR SINK GAR. SO. FT. @ POWER OUTLET ROOF DRAINS CARP. S0. FT. GAS (ROUGH) DRAINAGE PIPING WALL SO. FT. @ OTHER APPJEOUIP. DRINKING FOUNTAIN SO. FT. @ TEMP. POLE URINAL ESTIMATED CONSTRUCTION VALUATION $ GROUT WATER PIPING NOTE: Not to be used as property tax valuation FINAL INSP. FLOOR DRAIN MECHANICAL FEES WATER SYSTEM WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER NAL INSP. / G 5cu. 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 r' HP POLE, TEM/PERM 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 GAR. FIREWALL SO.FT.GAR @ 3/ac HOUSE SEWER LATHING 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 APPJEOUIP. REINF. STEEL GAS (FINAL) • TEMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM GRADING d y , ,$ plus x$ =$ LUMBER GR. NAL INSP. / G 5cu. 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