9699 (PLBG)40.4 4 a No. 9699
P. BOX 150
Building 78-105 CALLE ESTADO
Address 49-941 COACEELLA LA QUINTA, CALIFORNIA 92253
Owner
BOUTIN
BUILDING: TYPE CONST.
ILe
SEWER U6Wt gFrp..
Mailing
Address S ALI E
A.P. Number
City -
Zip
Tel.
LA qUINTA9,CA
192253
1
gal Description
Project Description
SEWER HOOKUP
Contractor
VALLEY PLUMBING
Address
46-780 CLINTON ST.
city
Zip
T
INDIO,CA
192201
347-3629
State Lic.
City
&Classif. 273088
Lic. # I I
Sq. Ft.
No. No. Dw.
Size.
Stories Units
Arch., Engr.,
Designer
New 0 Add 0
Alter 0 Repair 0 -Demolition 0
Address
Tel.
City
Zip
State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
J hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
V000) of Division 3 of the Business and Professions Code, and my license is in full force and
effect.
SIGNATURE DATE
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,..dernolish, 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 provision of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
s
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 civilpenally ofnot more than five hundred dollars ($500).
.,0 1, 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 putpose of sale.)
b 1, 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.)
0 1 am exempt under Sec.—B. & P.C. for this reason
Estimated Valuation
$1,500
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Date Owner
Infrastructure
WORKERS? COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self -insure, or a Certificate of
Worker's Compensation Insurance, or a certifiedcopytereotnte
W00, Labor Code.)
P icy No. --Company ak la 2
6Copy is filed with the city.. 0 Certified copy is hereby furnished.
i. I i4
d", 'i 430.00
TOTAL
U
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
REMARKS
(This section need not be completed it the permit Is for one hundred dollars ($ 100) valuation
or less.)
I certify that in the performance of thp work for which this permit is issued, I shall not
employ any Ferreon in any manner so as to become subject to the Workers' Compensation.
Laws of Cali 0 n a.
'Date—L---Owner
NOTICE TO APPLICANT. If, after making this Certificate of Exemption you'should become
subject to the Workers' Compensation provisions of the Labor Ccide, you must forthwith
comply with such Provisions or this permit shall be deemed revoked.
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 Nam
Lender's Address
FINAL DATE
—INSPECTOR
This is a buildin� permit when properly filled out, signed and validated, and is subject to
expiration it work I ereunder is suspended for 180 days.
I certify that I 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.
Issued by:
Validated by:
—Date—Permit
Signature of applicanj Date—
Maiii ' ng Address
Validation:
City, State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. Fr. @ $
UNITS
COLL. AREA
SLAB GRADE
YARD SPKLR SYSTEM
2ND FL. SO. FT. @
HEATING (ROUGH)
STORAGE TANK
POR. SO. FT. @
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. @
POWER OUTLET
ROOF DRAINS
FOUND. REINF.
DRAINAGE PIPING
CAR P. I SO. FT. 0
HEATING (FINAL)
OTHER APPJEOUIP
WALL SO. FT. @
DRINKING FOUNTAIN.
SO. FT. @
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM. FAN EVARCOOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
FINAL INSP.
ILAUNDRYTRAY
AIR HANDLING UNIT CFM
IKITCHEN SINK
ABSORPTION SYSTEM B.TiU.
TEMP USE PERMIT SVC
I WATER CLOSET:
COMPRESSOR HP
POLE, TEMIPERM
ILAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER. B.T.U.
SO. FT. @ c
BATH TUB
FIREPLACE
SO. FT. @ c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U,
SO. FT. RESI D (6 IV, c
SEWAGE DISPOSAL
SO.FT.GAR @ 3/4c
I HOUSE SEWER
GAS PIPING
PERMIT FEE
PERM FEE
PERMITFEE
DBL
TOTAL. FEES
MICRO FEE
MECH.FEE PL.CK.FEE
OONST.-FEE ELECT.FEE
SMIFEE 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 TAN
OUGH� 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
cu.yd.
$_plus_x$_=$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTIOff -7 1114
CERT. OCC.
FENCE FINAL
INSPECTOWS SIGNATURESIINITIALS.
GAR QE N WALL FINAL