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11654 (PLBG)Building Address 53-470 OBn(;ON COACHELLA VALLEY LAND 4 P.O. BOX 1504 78.105 CALLE ESTADO LA QUINTA, CALIFORNIA 92253 Mailing Address 74225 HWY 111, STE. C City Zip Tel. •PALK DESERT T92260 568-0855 Contractor SANTA ROSA CONST. Address 74225 HWY 111, STB L City Zip PALH DESERT 92260 State Lic. & Classif. 565814 Tel.: Lic. # 2001 Arcn., Lngr., Designer Address Tel. City 1. 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 foff the'Business and Professions Code, and.my license Win full force and effect. SIGNATURE .r� DATE , v OWNER -BUILDER 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, alter, 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 or Section 7031.5 by any applicant- for permit subjects the applicant to a civil penalty of not more than five hundred dollars.($500). - 0 1, 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 tha( 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. of proving that he, did not build or improve for the purpose of sale.) ❑ 1, 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 pursuantto the Contractor's License Law.) ❑ 1 am exempt under Sec. B. & P.C. for this reason Date Oi _ ,, r /.If 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 WORKERS'COMPENSATIONINSURANCE - (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 thq work for which this permit is issued, I shall not employ anyparson 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 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. 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 LDING: TYPE CONST P. Number No. 116.54 OCC: GRP. Legal Description Project Description SEVIER HOOKUP Sq. Ft. No. No. Dw. Size Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation $11500 PERMIT - AMOUNT. Plan Chk. Dep. Plan Chk. Bal Const. Mech! Electrical Plumbing $30.00 S.M.I. . Grading Driveway Enc. Infrastructure AL r.1'r.s .. '. {-'i s'r�i F }.r Ak dq.(.Yjt— .i. 410 TOTAL 3U • �7 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. PLUMBING FEES 1ST FL. SO. FT. ® $ UNITS F 2ND FL. SD. FT. YARD SPKLR SYSTEM POR. SO. FT. ® MOBILEHOME SVC. BAR SINK GAR. S0. FT. ® POWER OUTLET ROOF DRAINS CAR P. S0. FT. DUCT WORK DRAINAGE PIPING WALL SO. FT. DRINKING FOUNTAIN. SO FT ® HEATING (FINAL) 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.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED GRADING cu. yd. $ -plus-x$_=$ LAUNDRY TRAY 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 ® 11/4 c SEWAGE DISPOSAL FIREPLACE SO.FT.GAR ® 3/ac HOUSE SEWER SPARK ARRESTOR 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 ORyt'PTT4fIk-+ OUGH WIRING. DUCT WORK ROCK STORAGE FOUND. REINF. GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APPJEOUIP. 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 INSULATIONISOUND FINISH GRADING FINAL INSPECTION j�( 0 111��000 f� CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURES/INITIALS GARDEN WALL FINAL Remarks 0 COPY to: Cash Check Money Order TOTAL $ WaterServIce Cashier CVWD-438 (11189) COACHELLA VALLEY WATER DISTRICT CASH RECEIPT DETAIL Rec;ived From: f Address: Date:. --, Account No. Lot(s) Traci. Service Address )-e. G.A. Code -7. 0 Meter(s) $ 0 Service(s), 0 Backflow(s) 0 House Laterals) 0 Detector Check(s) 0 Meter Surcharge 5191alw"tation Capacity Charge' 0 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 Sewer - Tract - 0 Bond Payment - A.D. - Bond Assmt. 0 Customer Deposit 0 Other Remarks 0 COPY to: Cash Check Money Order TOTAL $ WaterServIce Cashier CVWD-438 (11189)