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14519 (SIGN)44 litif Qumr6.. P.O. BOX 1504 Building ' 78-495 CALLS TAMPICO Address 50-92.1'Washington #S LA QUINTA, CALIFORNIA 92253 Owner Video Depot Mailing Address Same, City Zip Tel La Quinta s. 92253 13 Contractor Signs & Setvices Address . 10980 Boatman- Ave. No. 14519 BUILDING: TYPE C_ ONST. OCC: GRP A.P. Number 46-3492 Legal Description Project Description- (3).. Will Signs Video De -rat . R: zj toll, CA ZIP 90680 '614).761-i--'8200 StatefLic. City & Classif... C-45 43*828 Lic. # -3543 Sq. Ft. Size - •- Arch.;' Engr.; Designer New ❑ Address Tel. .City.. Zip State Lic. # No. No. Dw.- Stories.- Units Add.❑ Alter 0. Repair.❑ LICENSED CONTRACTOR'S DECLARATION 71 1 hereby affirm that f am licensed under provisions of Chapter 9 (commencing wifh'Section ' 7000) of Division 3 of the Bu iness a-ndd P fess ons^/ e, �fifld my license i in full force nd effect. - _�_� �•, l�✓ .. �..: �j� . SIGNATURE I DATE _ '- OWNER BUILDER DECLARATION Estimated Valuation g AA Ain I hereby affirm that I am exempt from the Contractor's License Law for the following ' 'P I � v 4. � 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 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 five hundred.dollars ($500)., ' - . . .. 0, 1, 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. - a Q� Professions Code: 'The Contractor's License Law does not apply to an owner or 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 knprove for the purpose of sale.) .. . ❑ 1, as owner of the property, am exclusively contracting with licensed contractors -to con- Plumbing . 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) Pcensed pursuant to the Contractor's License Law.) • - - Grading O •I am exempt under Sec. B. & P.O. 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.) - Poljcy No. Company Copy is -filed with the city. .❑ Certified copy is hereby furnished. TOTAL 54.00 CERTIFICATE OF EXEMPTION FROM '. ' REMARKS WORKERS'COMPENSATIONINSURANCE (This section need not be completed• ff 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:. H, after making thisCertificate' of Exemption you should become, ZONE: - ' ` 'BY: r subject to the Workers' Compensation provisions of the Labor Code, - you must 'forthwith • - ,•. T' comply with such provisions or. this permit shall be deemed revoked. - Minimum Setback Distances:. - Front Setback from Center Line Rear Setback from Rear Prop. Lin WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL; AND • SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES.UP TO ONE 'Side Street Setback from CenterLlne ,rejy� HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, .: Side Setback from Property�La.ne ' DAMAGES AS PROVIDED FOR' IN SECTION 3706 OF THE LABOR CODE, INTEREST,- AND ATTORNEY'S FEES. /j This is a building permit when properly filled out, signed and, validated, and is subject to FINAL DATE INSPE TOR ��t t expiration if work thereunder is suspended for 160 days. A I certify that I have read this application and state that the above. information is correct. ISSUed. by: Date �� PeFfCJ fjAt I agree to comply with all city and county ordinances and state laws. relating to building constructlon, and hereby authorize representatives -of this city to enter the. above-: mentioned property for Inspection purposes.-'• Validated by: Signature of applicant Date' �\ y�tJ AL Address ValldatlOn: " City, State, Zip C Demontfon U ' CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES IST FL. SO. FT. ® $ 2ND FL. SO. FT. POR. SO. FT. ® GAR. SO. FT. @ CAR P. SO. FT. WALL SO. FT. ®' SO. FT. ® ESTIMATED CONSTRUCTION VALUATION $ UNITS MOBILEHOME SVC. POWER OUTLET YARD SPKLR SYSTEM BAR SINK I 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.COOL HOOD SIGN WASH ER(AUTO)(DISH) APPLIANCE DRYER GAS (ROUGH) GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED OTHER APPJEQUIP. LAUNDRYTRAY 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 SO. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 11/4 c SEWAGE DISPOSAL SO.FT.GAR ® 3/ac HOUSE SEWER REMARKS: 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 OR SEPTIC TANK ROUGH 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. FRAMING FINAL INSP. ROOFING 1. REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATION/SOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURES/INITIALS GARDEN WALL FINAL