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PLBG (12215)J. Building ' Address •53 -671 Mendoza Ow Vim Cit c,a_ rt Mailing . Address '' .-419.95 ,136ardwalk City Zip Palm eitj 92260 • I P.O. BOX 1504 78-105 CALLE ESTADO , LA QUINTA, CALIFORNIA 92253 .y- BUILDING: TYPE CONST ,564-41(14 Contractor R.V. sa.; P-1111 3in /Rick S evvinson Address requires the applicant .for such permit to file a signed statement that he is licensed pursuant to PERMIT 741.10 Veilardo Drive ' City -,pa3m •- •. ': --.Zip DeserL X2264 Plan Chk. Bal. Tel.: 341-9224 State Lic. do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and COr1St. City & Classif. .36 60. 2396 Mech. Lic. # 2325 Arch Engr or improvement is sold within one year of completion, the owner -builder will have the burden Electrical of proving that he did hot build or improve for the purpose o/ sale.) r Designer Address Tel. City Zip State `�•.' _ Lic.# �. •iF I S`EDCf�,`NTRACTOR'S��,D,ECLARATION I hereby affirrrp tsed unfler provisioljs'Af Chapter 9 Ice mencing with Section Ise is in full force and A.P. Number e+ Legal Description Project Description Sewer Connect Sq. Ft. No. Size Stories No. Dw. �> Units -s INew ❑ Add ❑ Alter ❑. Repair ❑ ` "r 1.r1'! - ^. OWNER -BUILDER DECLARATION I hereby affirm. that 1'am exempt from the Contractors License Law for the following reason: (Sec. 7031'5; Business and Professions Code,' Any city oricounty which requires a permit to construct,'• alter, � improve,' demolish,'or repair any structure, l prior, to Its issuance also Estimated ValUatF requires the applicant .for such permit to file a signed statement that he is licensed pursuant to PERMIT the provisions of the -Contractor's License. Law, Chapter 9 (commencing' with Section 7000) of ' Division 3 o/ the Business and 'Professions Code, or that. he is exempt therefrom, and the basis for the alleged exemption. Any violation Section 7031.5 by 'any for Plan Chk. Dep. of applicant a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500). Plan Chk. Bal. ❑ 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 COr1St. 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, 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 hot build or improve for the purpose o/ sale.) ❑ I, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing struct the project: (Sec. 7044, Business and Professions Code: The Contractor's License Law Demolitiori ❑ . 0000.00 AMOUNT • iJi! • doesnot apply. to an owner of property who builds or improves thereon, and who contracts /or .S.M•1. 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 Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.) Policy No. Company ❑ Copy is filed with the city. ` 0 Certified copy is hereby furnished. f , CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURA�NCV (This section need not, be - completed if the per t is /or one un ed dollars OJ valuation or less.)?' - . � I certify that in the performance" @ w k for which tt4 permit is issLed, 1 shall not employ any pers in any man r as o ecome ubject t t e o s' Compe S�1bn L'awCaliforn % t Da ` Owner, NO E TO AP ICANT:` Il, her a t is Certilic of Ex mption. you should b co e subject to the Workers' Co sation ovisions of the Labor Code, you must forthwith comply with such provisions or this permit sh I 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. 3 09 7, 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 - 7 TOTAL �� • REMARKS ZONE: BY: Minimum.Setback Distances: Front Setback from Center Line Rear Setback from Rear Prop. Line Side Street Setback from Center Line • Ate.... Side Setback from -Property Line FINAL DATE INSP ,77TUR 0 Issued by: Date ml Validated by: Al lP_ Validation: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SQ. FT. ® $ UNITS COLL. AREA 2ND FL. SQ. FT. ROUGH PLUMB. YARD SPKLR SYSTEM FOR. SQ. FT. ® MOBILEHOME SVC. BAR SINK GAR. SQ. FT. ® POWER OUTLET ROOF DRAINS CAR P. I SQ. FT. DUCT WORK DRAINAGE PIPING WALL SQ. FT. GAS (ROUGH) DRINKING FOUNTAIN. SQ FT ® HEATING (FINAL) URINAL ESTIMATED CONSTRUCTION VALUATION $ GAS (FINAL) WATER PIPING NOTE: Not to be used as property tax valuation FLOOR DRAIN MECHANICAL FEES WATER HEATER WATER SOFTENER VENT SYSTEM FAN EVAP.000L HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER WATER SYSTEM GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED GRADING cu. yd. $ Plus -X$-=$ 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 SQ. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SQ. FT. RESID ® 11/a c SEWAGE DISPOSAL SQ.FT.GAR ® 3/ac HOUSE SEWER SPARK ARRESTOR GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEE MECH.FEE IPL.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 SEWERS. -TAW C 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 cu. yd. $ Plus -X$-=$ LUMBER GR. FINAL INSP. FRAMING FINAL INSP. 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 SIGNATURES/INITIALS _ GARDEN WALL FINAL COACHELLA VALLEY WATER DISTRICT CASH RECEIPT DETAIL Received From: I G (�a���-_-•- / - Z� G '.'" L !"<" Da Address: —4/A � Account No. Lot(s) Trac G . d Service Address G.A. Code ❑ Meter(s) $ ❑ Service(s) ❑ Backflow(s) ❑ House Laterals) ❑ Detector Check(s) ❑ Meter Surcharge Sanitation Capacity Charge,orS O ❑ 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 TOTAL Remarks: ❑ Copy to: _ �m