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10377 (PLBG)-} P.O. BOX 1504 No, +0377' Building�� Obregon _ 78-105 CALLE ESTADO AddressLA QUINTA, CALIFORNIA 92253 Owner duillerato Bert udex BUILDING: TYPE CONST. Mailing Address 1196 Caballeros Ave. City Zip Tel. PalM Segs 92262 Contractor Rick Stevenson/M Plumbing Address P. 0. Box 692 LMircageel 92270 1 341--6546 State Lic. City & Classif. C36 632396 Lic. # 1914 Arch., Engr., Designer Address Tel. City IZip I State I Lic. # eby affirm that'I arri licensed undera}ovisionsfof Chapte 9 commencing with Section of Division 3f ih_e'Busineys and ProfS:CionsrCpd6`and my licegse is in fu"II•force and I hereby affirm that I am exempt from the Contractors 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 eriempt 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 rive hundred dollars.($500). ❑ 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. -1f, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden 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 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) licensed pursuant to the Contractor's License Law.) ❑ 1 am exempt under Sec. B. & P.C. for this reason Date 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 ❑ Copy is filed with the city. ❑ Certified copy is hereby, furnished. CERTIFICATE OF EXEMPTION FROM- I WORKERS' COMPENSATION INSURtNCE 9 (This section need not be completed if the permitlis for one hu dreddollars ($100 valuation or less.) I certify that in the performance ofdwork�fo\which��thls�per it is issued, I shall not employ any person in any,.mannev o tol6eEome ubj€ct to th orkers' Com ensation Laws of California. Il�A�1 subject to the Worke(s' Compensition provisions ofoithe Labdm;CFdde; you must comply with such provisionsthis-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 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 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 A.P. Number OCC: GRP.: Legal Description Project Description Sewer Honk BJP Sq. Ft. Size No. No. Dvil... Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation 1000.00 PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. Const. Mech. Electrical Plumbing 30.00 S.M.I. Grading Driveway Enc. Infrastructure TOTAL 30900 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: Date Permit Validated by: Validation: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBINC•FEES IST FL. SO. FT. a $ UNITS SLAB GRADE 2ND FL. SO. FT. ® BONDING YARD SPKLR SYSTEM POR. SO. FT. ® MOBILEHOMESVC. BAR SINK GAR. SO. FT. a POWER OUTLET ROOF DRAINS CAR P. SO. FT. GAS.(ROUGH) DRAINAGE PIPING WALL SO. FT. OTHER APPJEOUIP. DRINKING FOUNTAIN. SO FT a 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 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. a c BATH TUB SO. FT. a c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID a 1 Vi c SEWAGE DISPOSAL GAR. FIREWALL SO.FT.GAR a 36c HOUSE SEWER LATHING GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEE MECH.FEE PLCK.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 APPJEOUIP. REINF. STEEL GAS•(FINAy'r ' �. TEMP. POLE GROUT --:WATER. HEATER SERVICE FINAL INSP. BOND BEAM i 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 INSULATIONISOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL Received Fr m: COACHELLA VALLEY WATER DISTRICT CASH RECEIPT DETAIL In date: , Address: GS4 ic f �061 L) Accou'nt No.. Service Address -G.ik,. Codd a) W t 0 Service(s) % low(s) 0 :Back( 0 House Lateral(s) 0 Detector Check(s) 0 Meter Surcharge. 15 7 5 00 KSanitation Capacity Charge C1 W.S.B.F.C. 0 Temporary Construction Meter 0 Turn on Charge 0 Uncollected Account —Name 0 Inspection Fee - Tract - Fee - 0 Plan Check Fees Water I Sewer - Tract - 0 Bond Payment A.D. --Bond Assmt. A., Pv 0 Customer Deposit abther',` �6 N Z, bTAL 0000y to* str 3, Cash Az Wate rvii�'� M4 rSe Check Woney Order A+k