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15325 (RER)4 P.O. BOX 1504 No. 15325 Building 78-495 CALLE TAMPICO Address 55-111 Firestone LA QUINTA, CALIFORNIA 92253 ' s Owner El Newkirk Mailing BUILDING: TYPE CONST. • OCC. GRP. Address 55-111 Firestone. A.P. Number City Zip Tel. La EYr �a 92253 771-0 7 48 Legal Description Contractor Project Description Drywall replacement f©r 1 omeco BBC Fire Damage Address 72500 Beavertail St. g City Zip Tela Palm Desert 52260 346-2266 State Lic. City & Classif. B 354141 Lic. # 3537 Sq. Ft. No. No. Dw. Aft., Engr., Size " Stories Units Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Address Tel. City Zip s State Lic. # I LICENSED CONTRACTOR'S DECLARATION II ereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7 ) of Division 3 -of the gusinessiand,Profe�'s'ions Code, and my license is in full force and t effect. SIGNATURE" --T `3s" { Y DATE OWNER•9UILDER DECLARATION Estimated Valuation I hereby affirm that I am exempt from the Contractor's License Law for the following $2,200.00 reason: (Sec. 7031.5,Susiness 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 m 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. i subjects the applicant to a civil penalty of not more than five hundred dollars ($500). ❑ 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 s fy Professions Code: The Contractor's License Law does not apply to an owner of property who Const. 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 inprove for the purpose of sale.) ❑ I, 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.1. such projects with a contractor(s) ticensed pursuant to the Contractor's License Law.) ❑ I am exempt under Sec B. & P.C. for this reason Grading Driveway Enc. Date Owner Infrastructure WORKERS' COMPENSATION DECLARATION I hereby aff' that I have a„certificate of consent to self- insureror a certificate of WorkePs Co en bo Insurance,'ora certified copyAhereof ,(S�c. 3800, Labor Code.) Policy o. - 5 7/Com_pan,/ opy Is filed with the city.0 O Certified copy is he eby fu hished. TOTAL `�' • 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 ttlat in the performance of thg work for which this permit is jssued, I shall not enirploy%a�nayAd'erson in any manner�+}as to become su�tj/e_c�t)to the Workers' Compensation Daes olOwner _ l.. Cf/� / d� ��.• NOTICEjT A' PIJCANT: ` ,, aRakmg this Certificate of Exemption you should become subject to the Workers' Compensathm provisions of the Labor Code, you must /orthwith 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 ATTORNEYS FEES. This Is a building permit when properly filled out, signed and validated, and is subject to expiration it work thereunder is suspended for 180 days. I certify that I have read this application and state that the above information is correct: I agreeto 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, Stale, Zip REMARKS ZONE: BY: Minimum Setback Distances: Front Setback from Rear Setback from Side Street Setba, Side Setbackf FINAL DATE �r NS Issued by: Validated by: Validati CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBIW FEES 1ST FL. SO. FT. ® $ UNITS SLAB GRADE ROUGH PLUMB. BONDING YARD SPKLR SYSTEM 2ND FL. SO. FT. 0 FORMS SEWER OR SEPTIC TANK ROUGH WIRING MOBILEHOME SVC. BAR SINK POR. SO. FT. ® GAS (ROUGH) METER LOOP GAR. SO. FT. ® POWER OUTLET ROOF DRAINS GAS (FINAL) TEMP. POLE DRAINAGE PIPING CAR P. SO. FT. @ GROUT WATER HEATER WALL SO. FT. ® FINAL INSP. DRINKING FOUNTAIN SO FT ® WATER SYSTEM 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 EVAP.COOL HOOD SIGN WASH ER(AUTO)(DISH) APPLIANCE DRYER GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED VENTILATION LAUNDRYTRAY AIR HANDLING UNIT CFM FIRE ZONE ROOFING 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 LATHING SO. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 1V. c SEWAGE DISPOSAL SO.FT.GAR p 3/ac HOUSE SEWER 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 APP./EQUIP. 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 INSULATION/SOUND FINISH GRADING FIN INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESlINIT1ALS GARDEN WALL FINAL