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PLBG (09397)P.O. BOX 1504 No,. - 9397 Building 78-105 CALLE ESTADO ' Address 78-990 -MILES - AVENUE- LA QUINTA, CALIFORNIA 92253 Owner,:. t. l_ SS EVRR VISTA DUNES MOBILE PAS - y HOOKUP Mailing " BUILDING: TYPE CONST. OCC: GRP: Address A.P. Number ' City ZipJTel: LAQI'�AS .CR 2253321-7A48 Legal Description i. 14RRRR gnnvftry b R.Jy 4friQ'#w ` Contractor. - • Project Description 1 SEPTIC-TANK A 9' SEEY�'�tiCE PITR . HAMS iR SEWER CONSTRUCTION INC. Address _. WOR 41 • R�►ILER PASS . 66§ PEREZ _ City Zip Tel.: rATU'RET__JI C _ �r State. Lic.• ' ': City ;' y & Classif.' Lic. # Sq. Ft. No. No.fDw 420275 1138 Size Stories Units ti{' Arch., ,Engr.,= # ... DesignerQAA , R� s - 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 „ x•; 7000) of Division 3 of,the Business and Professions Code,. and my license is in full force and effecti SIGNATURE Y {_' DATE ` ` OWNER-BUILDER DECLARATION Estimated ValUatlOn I hereby affirm that I am exempt from the Contractor's License Law for the following �S ��0 • reason: (Sec. 7031.5,Business and Professions Code: -Any city or,county which requires a• f permit ;to construct, atter, improve, demolish, or repair any .structure, prior to its issuance also r AMOUNT 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 o/ Section: 7031.5. by 'any applicant for a permit Plan Chk. Dep. _ subjects the applicant to a civil penalty of not more thamfive hundred dollars ($500). - `~ ❑ I, as owner of the property, or my employees with wages as their sole compensation, will Plan Chk. Bal. do the work, and the structure is not intended orlbffered 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. - - pro vided.that such improvements are not intended'oi,offered for sale. If, however, the building or improvement is sold within one year o/ compfetton,'lhe owner-builder will have the burden Electrical 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- Plumbing �. struct.lhe 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 S.M.I.- such projects-with a contractor(s) licensed pursuant to the Contractor's License Law.) *•„ - •, Grading r;,!`.0:I 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 t ., 'Worker's C en at'on In urance, or a'certified c_opX.thereof. (Sec.' 3800 Labor Code.) POIZoysry� { Company 3Iiri(iI HAS€© ;.. t No ❑ Copy is filed with the-city. ❑ Certified copy is hereby furnished. TOTAL S 90.00 CERTIFICATE OF EXEMPTION FROM REMARKS .. �. �- i• WORKERS' COMPENSATION INSURANCE (This, section-need not be completed if the permit is /or one hundred dollars ($100) valuation r - - ..or less.) certify that in the performance of ing 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. _ �- DatW Owner .rn L1 � ,. ± NOTICE TO -APPLICANT I/, ' affei maRFg . th sCertificate o/ xemption you should become ,ZONE: '�_'' BY: " subject io-the Workers' Compensation provisions of the Labor Code, you must forthwith Minirrium.Setback Distances: _ comply with such provisions or this permit shall be deemed revoked. + Front Setback from Center Line Rear,Setback from Rear Prop: Line' CONSTRUCTION LENDING AGENCY Side Street Setback from Center Line I hereby affirm that there is a construction lending agency for the performance of thet = work for which this permit is issued. (Sec. 3097, Civil Code.). Side Setback from Property, Llfle Lender's Name Lenders Address FINAL DATE INSPECTOR �- 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.3 .- I certify that I have read this application and state that the above information Is correct.. Issued by: Date Permit 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. Validated by: - Signature of applicant Date Mailing Address Validation: City, State, Zip Ifth �-� 4 . F ae4 . ,":. i .t`� cu}7y , t -s .�.r. `� - „9ia.t �,�'yi+ .. ,'`{ ..•-•.•j .+"_.. �,..°} Y i..- , .,.„'.3..-,_3._T'. .... :�t. CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SO. FT. ® $ 2ND FL. SQ. FT. FOR. SO. FT. ® GAR. SQ. FT, ® CAR P. SQ. FT. WALL SQ. FT. ® SO. FT. ® ESTIMATED CONSTRUCTION VALUATION $ UNITS MOBILEHOME SVC. POWER OUTLET YARD SPKLR SYSTEM BAR SINK ROOF DRAINS DRAINAGE PIPING DRINKING FOUNTAIN. URINAL WATER PIPING NOTE: Not to be used as property tax valuation SLAB GRADE FLOOR DRAIN MECHANICAL FEES WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASH ER(AUTO)(DISH) APPLIANCE DRYER EWER OR SEPTIC TANK to GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED DUCT WORK 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. SQ. FT. ® c BATH TUB SQ. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 11/4 c SEWAGE DISPOSAL BOND BEAM SO.FT.GAR ® 3/ac 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 EWER OR SEPTIC TANK to ROUGH WIRING DUCT WORK ROCK STORAGE FOUND. REINF. GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APPIEQUIP. 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 Received F Address: Account No. Lot (s) Service Address w ❑ Meter(s) ❑ Service(s) ❑ Backflow(s) ❑ House Lateral(s) ❑ DetectorCheck(s) ❑ Meter Surcharge �Sanitation Capacity Charg� ❑ W.S.B.F.C. ❑ Temporary Construction Meter ❑ Turn on Charge ' ❑ Uncollected Account - Name ❑ Inspection Fee - Tract - .t Fee - Plan Check Fees Water - Tract - ' O Bond Payment - A.D. - Bond Assmt. ❑ Customer Deposit " r Other�LLy'l i r r �Nx COACHELLA VALLEY WATER DISTRICT CASH RECEIPT DETAIL • Remarks: - .. ❑Copy to: Cash Check t" jd Money !` Order * `\ r t Received F Address: Account No. Lot (s) Service Address w ❑ Meter(s) ❑ Service(s) ❑ Backflow(s) ❑ House Lateral(s) ❑ DetectorCheck(s) ❑ Meter Surcharge �Sanitation Capacity Charg� ❑ W.S.B.F.C. ❑ Temporary Construction Meter ❑ Turn on Charge ' ❑ Uncollected Account - Name ❑ Inspection Fee - Tract - .t Fee - Plan Check Fees Water - Tract - ' O Bond Payment - A.D. - Bond Assmt. ❑ Customer Deposit " r Other�LLy'l i r r �Nx COACHELLA VALLEY WATER DISTRICT CASH RECEIPT DETAIL • Remarks: - .. ❑Copy to: Cash Check t" jd Money !` Order * `\ r 0