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03934 (RPL)4 �+ P.O. BOX 1504 Building 78-105 CALLE ESTADO Address 4� �,'*� 12i Calle S� �af� LA, QUINTA,.•CALIFOR,NIA 92253 Owner -. Walter F'rebiritlez BUILDING: TYPE CONST. OCC. GRP. MailinAddress �e �... K A 617-.A90-044 A.P. Number CitiaZipTel. QUinta��w�J _$04751 Legal Description Contractor Spa ��,� �� Project Description Address 43-375 Madison street CityIndio ZiP 92201 Tel. p .F (This section need not be completed if the permit is for one hundred dollars ($100) valuation State Lic. & Classif. 348768' City Lic. # Sq. Ft. Size r No. No'IDw. 'Stories Units"- Arch., Engr., Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Address Tel. NOTICE TO APPLICANT: It, after making this Certificate of Exemption you should become ZONE: BY: subject to the workers' Compensation provisions of the Labor Code, you must forthwith Minimum Setback Distances: City Zip State Lic: # Front Setback from Center Line LICENSED CONTRACTOR'S DECLARATION t •• I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 off-'fh�e•dusiness and.,Pr fessions Code, and my license is in full force andeffe6y CONSTRUCTION LENDING AGENCY Side Street Setback from Center Line I hereby affirm that there is a construction lending agency for the performance of the - 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, 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 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 five 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, Bussness 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 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 Estimated Valuation sar00VA ' PERMIT - AMOUNT Plan Chk. Dep. P Plan Chk. Bal. 0,42--- Const.. • 0 Mech. : b o ' Electrical TV • Uill . Plumbing 12 • 00 S. M. 1. •. 4.60 Grading Driveway Enc. WHITE FINANCE PINK APPLICANT GREEN - BUILDING, -GOLDENROD ASSESSORS OFFICE, HARD COPY -FILE , 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 O Copy is filed with the city. ❑ Certified copy is hereby furnished. Ai 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 ;a �y p: • •-fiJ0 -F.�:�Y'..e� .,Ifj,1 4 7-§4, 49 { A 6 MA or less.)ft4� I certify that in the performance of thg work for which this permit is issued, I shall not x ri J- Te employ any person in any manner so as to become subject to the Workers' Compensation , Laws of California. O NOTICE TO APPLICANT: It, after making this Certificate of Exemption you should become ZONE: BY: subject to the workers' Compensation provisions of the Labor Code, you must forthwith Minimum Setback Distances: comply with such provisions or this permit shall be deemed revoked. 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 This is a building, permit when properly filled out, signed and validated, and is subject to SPECT R FINAL DATE INN r expiration if work thereunder is suspended for 180 days. P ' Icertify that I have read this application and state that the above information is correct. 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- bove mentioned mentioned property for inspection purposes. Validated by: Signature of applicant Date Mailing Address Validation: City, State, Zip WHITE FINANCE PINK APPLICANT GREEN - BUILDING, -GOLDENROD ASSESSORS OFFICE, HARD COPY -FILE , .i _ .��. ✓. . � tt-,. _ - .., r_. 1'1,. '�x� � f ✓ �'.i..•..1.. , ...._ ..n +'.' .-.t^.:..,.t µti:... ,. .,• ...1-. r • CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES iST FL SO FT y $ 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. a GAS (ROUGH) METER LOOP HEATING (FINAL) POWER OUTLET ROOF DRAINS GAR SO. FT. a TEMP. POLE GROUT DRAINAGE PIPING CAR P. SO FT. B FINAL INSP. BOND BEAM WATER SYSTEM DRINKING FOUNTAIN WALL SO. FT. Q -$ , 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 WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTONDISH) APPLIANCE DRYER GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED ILAUNDRYTRAY 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, a c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID a1Y. c SEWAGE DISPOSAL FINAL INSPECTION SO.FT.GAR @ 3/.c HOUSE SEWER CERT. OCC. 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 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 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 INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL