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04787 (PLBG)1 f`� Addrdess ,x `, 5�.'• Owner T4ht 4 4 Q" �y`•..'� .oto Owen All Mailing— Address `Address :,•,� City lZip ITel. P.O. BOX 1504 78-105 CALLE ESTADO LA QUINTA, CALIFORNIA 92253 Contractor RoManS Etri. & Air Conde, ZnC.. Address. 80-300 Avenue 50, Box 18'9 CityZip Tel. Indio 29101 -347°-6253 . State Lic. City & Classif. Lic. # Arch., Engr., Designer Address Tel. Cityip ( State (Z v Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby'afflrm that I am licensed under provislons of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and SIGNATURE— DATE OWNER -BUILDER DECLARATION 1 -hereby affirm that 1 am exempt from the Contractor's License Law for the following reason:, (Sec. 703,1.5, Business and Professions Code: Any city or county which requires a permff to construct, atter, 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 Of4he°13,usiness 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 (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 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 safe. If, however, the building or improvement- is sold within one year of completion, the owner -builder will have the burden or proving that he did not build. or improve for the purpose of 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) 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 to 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 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 inlany manner so as to become subject to the Workers' Compensation Laws of California. Date Owner NOTICE TO APPLICANT: If, after making this Certificate or 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. BUILDING: TYPE CONST. OCC. GRP A.P. Number Legal Description Project Description ` heating 773-131-009 install ciao unit line a now FINAL DATE INSPECTOR 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. 1 Y,9 / $ R 11/9/SR 1 certify that I have read this application and state that the above information is correct. Sq. Ft. Size No. Stories No. Dw. Units New ❑ Add O Alter ❑ Repair O Demolition O Validated by: Signature of applicant Date Mailing Address Validation: City„ State, Zip WHITE - FINANCE, PINK - APPLICANT, GREEN -.BUILDING, GOLDENROD - ASSESSOR'S OFFICE, HARD COPY - FILE a Estimated Valuation PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. Const. Mech.i�. C1t3 Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure TOTAL REMARKS ,s1r-=•r. ,: a-„Y'Y ri�Y'Y,i'.._.Y'iY7Y':ir�' �:'r ?JxY ., �jb t��.J kwY ZONE: BY: 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 FINAL DATE INSPECTOR 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. 1 Y,9 / $ R 11/9/SR 1 certify that I have read this application and state that the above information is correct. 1 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 WHITE - FINANCE, PINK - APPLICANT, GREEN -.BUILDING, GOLDENROD - ASSESSOR'S OFFICE, HARD COPY - FILE CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES IST FL SO FT ¢7 $ UNITS SLAB GRADE ROUGH PLUMB BONDING YARD SPKLR SYSTEM 2ND FL SO FT. a FORMS SEWER OR SEPTIC TANK ROUGH WIRING MOBILEHOME SVC. BAR SINK POR SO FT Qt GAS (ROUGH) METER LOOP HEATING (FINAL) OUTLET ROOF DRAINS GAR SO. FT. 0POWER TEMP. POLE GROUT DRAINAGE PIPING CAR P. SO FT. 6 FINAL INSP. BOND BEAM WATER SYSTEM DRINKING FOUNTAIN WALL SO. FT. V -$ LUMBER GR. • FINAL INSP. URINAL SO. FT. (a ROOFING ESTIMATED CONSTRUCTION VALUATION $ WATER PIPING NOTE: Not to be used as property tax valuation FLOOR DRAIN MECHANICAL FEES VENTILATION WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER FIREPLACE 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. SO. FT. ® c BATH TUB • SO. FT. @ c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID Tei. c SEWAGE DISPOSAL SO.FT.GAR rg 3i c HOUSE SEWER CERT. OCC. GAS PIPING FENCE FINAL 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 8 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 APP.IEOUIP. REINF. STEEL L1CGAS (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