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15621 (PLBG)-s Building Address Owner 4 P.O. BOX 1504 78-495 CALLE TAMPICO. 52-020 AVe. Ramirez LA QUINTA, CALIFORNIA 92253 Lou Slack Mailing Address }; ame City Zip Tel. La Quintal C� 9225? '�i1m3i35 Contractor Cortet a Associates Address 13632 Cedar St. Ci�ty 5iesperia, -CA Zip 92345 Tel.: State Lica �� 6 5 2 City & Classif.. Lic. # Arch., Engr., Designer Address Tel. City (Zip ( State Lic. # LICENSED. CONTRACTOR'S DECLARATION I hereby affiim.thaI I Iiceasedd y�er provisions of Chapter 9 (commencing with Sectign 000) . t fn i` a ju'sl/�se!anr ssions Code, and my license is in full for ander ect. G.- r..-'- f ,f'- T,f�! SIGNATURE' 'Y DAT OWNER -BUILDER 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 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 rive hundred dollars (8500). ❑ 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 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 contractors) licensed pursuant to the Contractor's License Law.) O 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 completedr"e,permit is for one hundred dollars ($100) valuation 01 less.) / I certity�that in the performance of�thork f hicJlhierpermit is issued, I shall not .ryd ploy any ppeiso many mar�nerso asst becd ject'o t17� Workers'Compensat ion LBWS obCal fo'r iti jr,' Date � -� Owner �f L.-� �!f' ,�// i NOTICE' TO APPLICANT: nr offer making this Certca e"mpfion yoo should become subject to' the Workers' Compensation provisfons o! the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed ref ked. 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, No. 15621 BUILDING: TYPE CONST. OCC: GRP. A.P. Number Legal Description Project Description Change out water heater only Sq. Ft. No. No. Dw. Size Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ 5timated Valuation $438,09 ' I PERMIT AMOUNT, Plan Chk. Dep. Plan Chk. Bal. Const. Issued by: - Mech. Electrical Plumbing 30.00 S.M.I. Grading Validation: Driveway Enc. Infrastructure TOTAL 30.00 REMARKS ZONE: BY: Minimum Setback Distances: Front Setback from Center Line Rear SetbackJrom Rear Prop. Line Side Street etback from Center Line Side -Se back from Preert`y Line DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ' ATTORNEY'S FEES. FINAL DATE a building per)t when properly filled out; signed and validated, and is subject to This is m 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. Issued by: - 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 CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBIW FEES , 1ST FL. SO. FT. ® $ UNITS SLAB GRADE �' j BONDING YARD SPKLR SYSTEM f 2ND FL. SO. FT. FORMS SEWER OR SEPTIC TANK ROUGH WIRING MOBILEHOME SVC. BAFfSINK 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 I WATER HEATER WALL SO. FT. ® FINAL INSP. DRINKING FOUNTAIN. BOND BEAM WATER SYSTEM / URINAL SO. FT. o$ LUMBER GR. 111 ESTIMATED CONSTRUCTION VALUATION $ FINAL INSP. WATER PIPING NOTE: Not to be used as property tax valuation FLOOR DRAIN MECHANICAL FEES WATER SOFTENER VENT SYSTEM FAN EVAP.000L HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE I DRYER GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED FIRE ZONE ROOFING LAUNDRYTRAY AIR HANDLING UNIT , CFM FIREPLACE 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 ® 1 Va c SEWAGE DISPOSAL j SO.FT.GAR ® 3/ac HOUSE SEWER. 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 APP.IEOUIP. REINF. STEEL I GAS (FINAL) TEMP. POLE GROUT I WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM / GRADING cu. yd. $, plus x$ o$ LUMBER GR. 111 {�/ liv FINAL INSP. FRAMING FINAL INSP. ��IIf ROOFING REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING J MESH INSULATIONISOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL, INSPECTOR'S SIONATURESIINITIALS GARDEN WALL FINAL CORTEZ COD: CK# CASH E] CREDIT CARD -0 TOTAL DUE$: NOTICE TO CUSTOMER: Do not sign thl dnt until the I �T tion Ile satfs' , factorily completed. P REMARKS: CUSTOMERR E: INSTALL[ GRID: '� ZC-6A1 ATES 1.1363 2CEDAR ST.. (619) `�0,,.51-3363 H SOERIA, '.CA 92345 (60%,742110866 DEALER: DEL. DAY: oft* Lim Q* STORE:- Z_AC� S4t)�, DATE: CX\ C) INVOICE #: 7Z - CONTROL # CUSTOMER NAME: ADDRESS: CJ Z QZ G Q (L-eu (2 -(.LZ APT/SP#. CITY: p" Q zip: TELE. # -7 1 1 SPECIAL* INSTRUCTIONS: DESCRIPTION MODEL# COLOR SERIAL # LOCATION WAIVER OF RESPONSIBILIZ..taToploper , e(s) - , ly install, h liag s) lis d, I understand that thd , opliinceinstaller recommends cement of those parts listed below. I expressly refuse the ll' n of those p ch- bil'` "-and .1 accept full responsibility for any resulting due to those old parts not being replaced. r n SIGNATURE: DATE YES NO WORK PERFORMED PRICE A-,,) LC2:J1 C', CORTEZ COD: CK# CASH E] CREDIT CARD -0 TOTAL DUE$: NOTICE TO CUSTOMER: Do not sign thl dnt until the I �T tion Ile satfs' , factorily completed. P REMARKS: CUSTOMERR E: INSTALL[ GRID: