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15213 (PLBG)P.O. BOX 1504 Building 78-495 CALLE TAMPICO Address 32-745 Ave. ®hret, an LA QUINTA, CALIFORNIA 92253 owner Cochella Valley Land Address 7F®130 Ca le Tampico 0230 City Zip Tel. La Qiintao CA 92253 554-5522 C�on,,t,r.,a„ctor. 1iYa2.ler/ BuildeY' Address City Zip I Tel.: State Lic. I City & Classif. Lic. # 'Arch., Engr:, Designer Address Tel. City IZip 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 OWNEWBUILDER 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 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 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, Buisness 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 or completion; the owner -builder will have the burden of proving that he did not build or improve for the purpose of sale.) ©eras 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) #censed pursuaol..to the Contractor's License Law.) 0 1 am exempt under Sec. -4f' B.'8 P.C. f -ti's real , r Dat" 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 & dopy is filed with the city. ❑ 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 California. Date Owner NOTICE TO APPLICANT: N, after 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 it work thereunder is suspended for 180 days. I certify. that I have read this application and stale 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 No. 15213 BUILDING: TYPE CONST. OCC. GRP. P. Number Legal Description Project Description Sewer Connect TOTAL 30. U0 REMARKS ZONE: BY: Minimum Setback Distances: Front Setback from Center Line Rear Setback from Rear Prop. Line Side Street Setback from Center Line Side Setback from Property Line FINAL DATE INSPECTOR Issued by:: Validated It Validation: Sq. Ft. Size No. No. Dw. Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ 'Demolition ❑ Estimated Valuation $1,200.00 PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. Const. Mech. Electrical Plumbing 30. 00 S.M.I. Grading Driveway Enc. Infrastructure A TOTAL 30. U0 REMARKS ZONE: BY: Minimum Setback Distances: Front Setback from Center Line Rear Setback from Rear Prop. Line Side Street Setback from Center Line Side Setback from Property Line FINAL DATE INSPECTOR Issued by:: Validated It Validation: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBINUPES 1ST FL. SO. FT. ® $ UNITS SLAB GRADE 2ND FL. SO. FT. ® BONDING YARD SPKLR SYSTEM POR. SO. Ff. ® MOBILEHOME SVC. BAR SINK GAR. SO. FT. ® POWER OUTLET ROOF DRAINS ) GAS (ROUGH) DRAINAGE PIPING CAR P. SO. FT. OTHER APPJEQUIP. REINF. STEEL WALL SO. FT. TEMP. POLE DRINKING FOUNTAIN. SO. FT. ® GROUT URINAL ESTIMATED CONSTRUCTION VALUATION $ FINAL INSP. WATER PIPING NOTE: Not to be used as property tax valuation WATER SYSTEM FLOOR DRAIN MECHANICAL FEES _ =$ WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED REMARKS: LAUNDRY TRAY AIR HANDLING UNIT CFM 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. SQ. FT. ® c BATH TUB SQ. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 1+/4 c SEWAGE DISPOSAL SO.FT.GAR ® 3/<c 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 ROUGH WIRING DUCTWORK ROCKSTORAGE 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 FINAL INSP.. FRAMING FINAL INSP. ok ROOFING REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATIONISOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATUREWINITIALS GARDEN WALL FINAL 4 COACHELLA VALLEY WATER DISTRICT . 490 t CASH RECEIPT DETAIL 5 -(,,Lt — / / i V Received From: C O f K f I'! C L-A (/fl L L. c �/ C.fI N!� CC . L Date 7- 6- /9 • % S � : Address: �7 �S C� C /= C T`/t /^tel � ! C r1 Z !�Pot AI Z:4 r -A T 72 S?, Account No. 60G> 122 $3. O. g Lot(s) TractS,4hnA ( 0111) iy Ft. ' i/. Service Address S?_ — 7a A V i . O 6-J1 i G.A. Code ❑ Meter(s) ❑ Service(s) ❑ Backflow(s) O House Lateral(s) O Detector Checks) ' ❑ Meter Surcharge natation Capacity Charge O W.S.B.F.C. ❑ Temporary Construction Meter ' O Tum on Charge O Uncollected Account - Name O .Inspection Fee - Tract - Fee - O Plan Check Fees Water I Sewer - Traci - ❑ Bond Payment- A.D.- Bond Assmt. O Customer Deposit O Other Remarks: O Copy to: Water Service Cashier CVWD-<3B (11189) Cash Check 11,Y Money Order TOTAL Water Service Cashier CVWD-<3B (11189)