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9680 (PLBG) IIIIIIIIIIIIIIIIIIIIIIIII63 4 uGl' cu IE Q Q P.O. BOX 1504 t No. 96 8 0 Building496$9 Avila 7&105 CALLE ESTADO Address LA QUINTA,CALIFORNIA 92253 Owner Brown BUILDING: TYPE CONST. OCC:GRP. Mailing Address A.P.Number City Zip Tel. La Guinta Legal.Description Contractor Project Description :cnnn seater Service SSR HOOK UP Address P. O. Brix 192 City Zip Tel.: P. D. 92260 346--2793 .State Lic. City &Classif. 46098 . Lic.# 342 Sq. Ft. No. -No. Dw. . Arch.,Engr., Size Stories Units Designer New ❑ Add ❑ Alter ❑ Repair ❑ -Demolition❑ Address Tel. City Zip State Lic.# LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 700f1)of Division 3 of the Bursine�and Professions Code,and my licenseis in f II forG.e-a %sSIGNATURE ^'- t• t.i' DATE OWNER-BUILDER DECLARATION Estimated Valuation I hereby affirm that I am exempt from the Contractor's License Law for the following reason: (Sec. 7031.5,Business and Professions Code: Anycity'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 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 rive hundred dollars($500). ❑I,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. Code: The;Contractor's License Law does not apply to an owner of property who builds or improves thereonland who does such work himself or through his own employees, "Meth. provided thatsuch 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 improve for the purpose of sale.) ❑I,as owner of the property,am exclusively contracting with licensed contractors to con- Plumbing 30.00 struct the project:(Sec. 7044, Business and Professions_Code: The Contractor's Ucense-Law-- does not apply to an owner of property who builds or improves thereon, and who contracts foro S.M.I. such projects with a contractor(s)licensed pursuant to the Contractor's License Law.) Grading ❑1 am exempt under Sec. B.&P.C.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 f Worker's Compensation Insurance,or a certified copy thereof.(Sec.3800,Labor Code.) Policy,No. Company Epcopy is filed with the city. ❑Certified copy is hereby furnished. TOTAL 30.00 CERTIFICATE OF EXEMPTION FROM REMARKS WORKERS'COMPENSATIONINSURANCE �y (This section need not be completed if the permit is for one hundred dollars $100 valuation _ (( >��{{ .�i,..��} ( or less.) N.- I certify that in the performance of thg 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: If, after making this Certificate of Exemption you should become ZONE: BY: subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. Minimum Setback Distances: Front Setback from Center Line Rear Setback from Rear Prop. Line CONSTRUCTION LENDING AGENCY Side Street Setback from Center Line Ihereby 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 FINAL DATE INSPECTOR 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. 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 sof this city to enter the above-. - mentioned property for inspection purposes. Validated by: Signature of applicant Date Mailing Address Validation: City, State, Zip CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SQ.FT.® $ UNITS 2ND FL. SQ.FT. YARD SPKLR SYSTEM POR. SO.FT.® MOBILEHOME SVC. BAR SINK GAR. SO.FT.® POWER OUTLET ROOF DRAINS CAR P. SQ.FT. DRAINAGE PIPING WALL SQ.FT.® DRINKING FOUNTAIN. SQ FT ® URINAL ESTIMATED CONSTRUCTION VALUATION $ WATER PIPING NOTE:Not to be used as property tax valuation FLOOR DRAIN MECHANICAL FEES WATER SOFTENER VENT SYSTEM FAN EVAP.000L HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED LAUNDRYTRAY 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.®c WATER HEATER MAX.HEATER OUTPUT,B.T.U. SO.FT.RESID®1Vi c SEWAGE DISPOSAL SQ.FT.GAR®3Ac 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 TAN 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 LUMBER GR. FINAL INSP. cu.yd. FRAMING FINAL INSP. $ plus x$ =$ ROOFING REMARKS. VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATION/SOUND FINISH GRADING FINAL INSPECTION- CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL