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11522 (PLBG)- 6 I P.O. BOX 1504 1j No. 11522 Buildilig 52-745 AVENIDA OBREGON78-105 CALLE ESTADO LA Q Address UINTA, CALIFORNIA 9.53 Owner BRISTOW., WILLIAM ASID DOROTRY Mailing Address SAME City Zip LA QDINTA 92253 Contractor ADC CORSTRUCTION Address LDING: TYPE CONST P. Number OCC: GRP._ Tel. . 564-3404 Legal Description Project Description SEALER HOOKUP 1436 BONNIE BEACH City -Tel.: Tel.: LOS ANGELES 90023 310-672-5383 ,:State Lic. `& City Classif. 042306137 Lic. # 2301 Sq. Ft. No. No. Dw. Size Stories Units Arch.,`Engr., 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 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. ' SIGNATURE DATE OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following Estimated Valuation 1 5'00 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 file a signed statementthat 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 Any Section 7031.5. 'any for Plan Chk. Dep. alleged exemption. violation or by applicant a permit ' subjects the applicant to.a civil penalty of not more than five hundred dollars.($500). . ' Plan Chk. Bal.. p_ 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 Const. Professions Code: The Contractor's License Law does, not apply.to'an owner o/ 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 improve for the purpose o/ sale.) .. ❑ I, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing $20.00 strucl the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law - does not apply to an owner of properly who builds or improves thereon, and who contracts for S•M.I. such projects with a contractors) licensed pursuant to the Contractor's License Law.) Grading - O I am exempt under Sec. B. 8 P.C. for this reason Driveway Enc. Date_:'; ' — %=owner •= t'1;=•• = =ice 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 ' ❑ Copy is filed with the.city. ❑ Certified copy is hereby furnished. • TOTAL $20.00 CERTIFICATE OF EXEMPTION FROM REMARKS WORKERS' COMPENSATION INSURANCE _ _ ; t • _ ��., �•-� � �_ : } i r �= � �'�'�� -y. � This section need not be completed if the ( p permit is /or one hundred dollars ($100) valuation ' or less )' ^r J • •t 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. Lit, n ' Date /.t :` +"c/. :owner `; +.. , � - =.c -e • .,..,� NOTICE TO APP CANT: IF 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. - CONSTRUCTION LENDING AGENCY 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.) Lender's Name Lender's Address This is a building permit when properly filled out,'signed and validated, and is subject to expiration if work thereunder is suspended for 180 days. 1, certify that I have read this application and state 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 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: Date Permit Validated by: Validation: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES IST FL. SQ. FT. ® $ UNITS SLAB GRADE 2ND FL SQ. FT. BONDING YARD SPKLR SYSTEM' POR. SQ. FT. MOBILEHOME SVC. BAR SINK GAR. SQ. FT. ® POWER OUTLET ROOF DRAINS CAR P. SQ. FT. @ GAS (ROUGH) DRAINAGE PIPING WALL SQ. FT. OTHER APPJEQUIP. DRINKING FOUNTAIN. SQ FT @ TEMP. POLE URINAL ESTIMATED CONSTRUCTION VALUATION $ GROUT WATER PIPING NOTE: Not to be used as property tax valuation FINAL INSP. FLOOR DRAIN MECHANICAL FEES WATER SYSTEM WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER FINAL INSP. GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED 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 r HEATING SYSTEM FORCED GRAVITY AMPERES SERV ENT SHOWER BOILER. B.T.U. SO. FT. ®c 1BATH TUB SQ. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 1 Vi c SEWAGE DISPOSAL GAR. FIREWALL 'SQ.FT.GAR ® 3Ac HOUSE SEWER LATHING 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 EWER OR-6E4IGNIP' OUGH 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 /n l/ REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATION/SOUND FINISH GRADING FINAL INSPECTION- b CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL P s y i a ••.,nh z,ri 7,7 COACHELLA VALLEY WATER DISTRICT CASH RECEIPT DETAIL �,, �"• I r. ' Date )�L.({.,�G� ` ! . /4 f2,�� h `� Received From: / / .. P r ' Address: �K (Z�Lot(s) 1 �� Tract Account No. c A. CL Service Address $. iJ Meter(s) ❑ Service(s) ❑Backflow(s) ❑ House Laterals) ❑ DetectorCheck(s) ❑ Meier Surcharge !'— %A"anitation Capacity Charge ❑ W.S.B.F.C. ❑ Temporary Construction Meter. ❑ Turn on Charge ' ❑ Uncollected Account - Name :. ❑ Inspection Fee —Tract - Fee - ❑ Plan Check Fees Water I Sewer - Tract'- ❑ Bond Payment - A.D. - Bond Assmt. ❑ Customer Deposit ❑ Other c:. TOTAL $ Remarks:. ❑Copy to: s Water Service Casty Check Money J Cas or_ CV1ND-438 (11189.): Order