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15523 (PLBG)'fGGf�AGV P.O. BOX 1504 Building 78-495 CALLE TAMPICO Address 77_615 Calle Potrero LA QUINTA, CALIFORNIA 92253 Owner Century 21/Pacific Crest Morcgtage Mailing Address 77-615 Calle Potrero City Zip Tel. La Quinta 92253 Contractor soon© Sever Service ------ P.O. Box 192 City � Zip Tel.: Palm Desert 92262 346-2793 State Lic. City &.Classif. C-42 480961 Lic. # 342 Arch., Engr., Designer Address Tel. CityI Zip I State Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) 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, after, 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 ($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 appy 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.) O 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.) 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 O Copy is filed with the city. 0 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 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 Callfornia. Date Owner NOTICE TO APPLICANT. If, alter making this Certificate of 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. 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 if work thereunder 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. Signature of applicant Date . Mailing Address City, State, Zip BUILDING: TYPE CONST Number No. 15523 OCC. GRP.: Legal Description Project Description Sewer Connect Sq. Ft. No. No. Dw. Size Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ stimated Valuation $5,000.00 r PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. Const. $30.00 Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure TOTAL + REMARKS ZONE: BY: Minimum Setback Distances: � Front Setback from Centerline Rear Setback from Rear Prop Line Side Street Setbbk from CeDter Line Side Setback rom y L e� FINAL DATE rPrrope INSPECTOR 'i i\��rmit Issued by: D 19S Validated bv: \\ / CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBINU FEES .� 1ST FL. SO. FT. ® $ 2ND FL. SQ. FT. p FOR. SO. FT. ® GAR. SQ. FT. ® CAR P. SO. FT. WALL SO. FT. SQ. FT. ® ESTIMATED CONSTRUCTION VALUATION $ UNITS MOBILEHOME SVC. POWER OUTLET YARD SPKLR SYSTEM BAR SINK ROOF DRAINS DRAINAGE PIPING DRINKING FOUNTAIN URINAL WATER PIPING NOTE: Not to be used as property tax valuation BONDING FLOOR DRAIN MECHANICAL FEES FORMS WATER SOFTENER VENT SYSTEM FAN EVAP.000L HOOD SIGN WASH ER(AUTO)(DISH) APPLIANCE DRYER GAS (ROUGH) GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED OTHER APPJEQUIP. LAUNDRY TRAY AIR HANDLING UNIT CFM TEMP. POLE 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 I-1 hle 7J •DijNAL INSP. /L/l SO. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 11/4 c SEWAGE DISPOSAL SQ.FT.GAR ® 3/ac HOUSE SEWER VENTILATION 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 R S LROUGH 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. I-1 hle 7J •DijNAL INSP. /L/l FRAMING FINAL INSP. ROOFING REMARKS: VENTILATION FIRE ZONE ROOFING ' FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATIONISOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIONATURESIINITIALS GARDEN WALL FINAL Wm V. ECONO SEWER SERVICES P.O. Box 192 PALM DESERT, CALIFORNIA 92261 AM RM ME 45982. PHONE 328-7760 346-2793. TOTALLABOR -7- ZS: -!?- PLEASE PAY FROM THIS 1NV91GE NO STATEMENT WILL BE MAILED TAX CUSTOMER'S ORDER NO. PHONE ME IC HELPER .STARTIN BILL TO ORDER TAKEN BY ADDRESS 11 . DAY WORK CONTRACT EXTRA CIT JOB NAME AND LOCATION " JOB PHONE ' DESCRIPTION OF PAYMENT TFRMC NFT to nAYS FROM naTF OF cFRytCF 1%% PER MONTH CHARGE AFTER 30 DAYS TOTAL MATERIALS TOTALLABOR PLEASE PAY FROM THIS 1NV91GE NO STATEMENT WILL BE MAILED TAX DATE COMPLETED WORK ORDERED BY TOTALAMOUNT $ (jl_o one home I amount due 0 Total billing to Signature % �i or bove work: or be mailed after of work tion FROOUIT 25&7 � Illc - I hereby acknowledge the satisfactory mplellon Of work Gram am 01471 of the above described work