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15866 (PLBG)P.O. BOX 1504 No. 15866 Building 78-495 CALLE TAMPICO Address 54--365 Avenida Ramirez LA OUINTA, CALIFORNIA 92253 Owner l` Mailing T `'Qjvtnta RaxiifvPar*rtern BUILDING: TYPE CONST. OCC. GRP. Address 3501 Jamboree Drive A.P. Number CityZip Tel. Newport Reach 192658 1 Legal Description Contractor Project Description sewer Connection CVIiE1flY!bL21.ldEr Address City Zip Tel.: State Lic. City & Classif. Lic. # Sq. Ft. No. No. Dw. Arch., Engr., Size Stories Units Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Address Tel. City Zip State Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 70pp) of Division 3 of the Business and Professions Code, and my license is in full force and effect. SIGNATURE DATE OWNER -BUILDER DECLARATION Estimated Valuation I hereby affirm that I am exempt from the Contractor's License law for the following $1300.00 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 file a signed statement that he is licensed pursuant to PERMIT AMOUNT 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 Plan Chk. Dep. subjects the applicant to a civil penalty of not more than rive hundred dollars ($500). ❑ I, as owner of the property, or my employees with wages as their sole compensation, will Plan Chk. Bal. do the work, and the structure Is not intended or offered for sale. (Sec. 7044, Buisness and Const. 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, Mech. 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 Electrical of 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- Plumbing 14 tin- 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.I. such projects with a contractors) Qcensed pursuant to the Contractor's License Law.) Grading 0 1 am exempt under Sec. B. 8 P.C. for this reason Driveway Enc. Date Owner Infrastructure 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. TOTAL CERTIFICATE OF EXEMPTION FROM REMARKS 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 the 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: ff, after making this Certificate of Exemption you should become ZONE: BY: subject to the Workers' Compensation provisions of the, Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. Minimum Setback Distances: Front Setback from r IE Lin i Rear Setback f ar Pr WARNING: FAILURE TO SECURE WORKERS'COMPENSATIONCOVERAGE ISUNLAWFUL. AND Side Street Set=frf3TnCenter ine SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE C/n HUNDRED THOUSAND DOLLARS ($100,000); IN ADDITION TO THE COST OF COMPENSATION, Side Setback/ : m Projierr Line DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND Jj ATTORNEY'S FEES. FINAL DATE SPECTOR 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. Issued by: Date Perm r 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. PLUM BIN4:FEES 1ST FL. SQ. FT. $ UNITS �. 2ND FL. SQ. FT. BONDING YARD SPKLR SYSTEM STORAGE TANK MOBILEHOME SVC. BAR SINK POR. SO. FT. ® DUCT WORK ROCK STORAGE GAR. SQ. FT. ® POWER OUTLET ROOF DRAINS j HEATING (FINAL) OTHER APPJEQUIP. DRAINAGE PIPING .' CAR P. SQ. FT. ® TEMP. POLE WALL SQ. FT. GROUT DRINKING FOUNTAIN. SO. FT. ® FINAL INSP. URINAL ESTIMATED CONSTRUCTION VALUATION $ WATER SYSTEM WATER PIPING NOTE: Not to be used as property tax valuation - _$ FLOOR DRAIN MECHANICAL FEES FRAMING WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER REMARKS: 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, 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 ® 1 Va c SEWAGE DISPOSAL SQ.FT.GAR ® 34c HOUSE SEWER INSULATION/SOUND 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 (5e> R S,50 WIRING DUCT WORK ROCK STORAGE FOUND. REINF. GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APPJEQUIP. 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. i i�✓ v Cv 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 -UUFV55: --; L., OfA., i -, n., �� - Lc ✓=la1PGK% ' 'SIC /' 9 r•g . Account No. (/ 3 Lot(s) '. ro/%/' �' • �% Service Address '�� /=J��L%1/ Tract . ❑ Meter(s) G.A. Code ❑ Service(s) $ ❑ Backflow(s) ❑ House Lateral(s) ❑ DetectorCheck(s) ❑ MeterSurcharge Sanitation Capacity Charge ❑ W.S.B.F.C.�. i J ❑ Temporary Construction Meter ❑ Turn on Charge ❑ Uncollected Account - Name ❑ Inspection Fee - Tract - Fee - 0 Plan Check Fees Water I Sewer - Tract - ❑ Bond Payment - A.D. - Bond. Assmt. ❑ Customer Deposit - -------- 0 Other Remarks: TOTAL ❑Copy to: Cash Check (,3.(��vUJ;?Ub < - Water Service — Order � Cashier) T" CVWD-438 (11/89) VALLEY WIDE PUT01PING SERVICE SOLDBV DATE' NA I - PHONE A DRESS �•-� ITV d / c 'vim QCASH k r ; CHARGE,"' rt €� i MERCHANDISE RETURNED DDO �AC�C,OUN.Tz.� �`f�'��,;�COD��"`" �Px.A��U��❑ a«:r h�z"i OTY. pESCRIPTION s PRICE I AMOUNT ;;. 2 d 5 - 6 8 9 10 12 /� ! 13 r ; n . 14 15 HIS BILL MUST AE PAID WITHIN 7 DAMS 16, E>'ADPED. RECEIVED BY TOTAL ' '! THANK YOU 4403 r Contents: 40% Pre -Consumer • 10% Post -Consumer