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15819 (PLBG)Building Address 52-560 .Ave Owner Lisa Amend Addressp•.p•. Box 3615 4 P.O. BOX 1504 N o • 15-819 78-495 CALLE TAMPICO t LA QUINTA, CALIFORNIA 92253 .City Zip Tel. ' j Palm Desert 92261 i j Contractor Steffen Plumbing No. Dw. Units Address P.O. Box 612 Alter ❑ City Zip Tela Xndio 92202 345-4353 p5^4353 State Lic. & Classif. 565175 C-36 City Lic. # 11 Arch., Engr., Designer .` Address Estimated Valuation Tel. City( Zip I 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 j effect. � SIGNATURE DATE OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following I reason: (Sec. 7031.5,8usiness and Professions Code: Any city or county which requires a j permit to construct, -after, improve, demolish, or repair any structure, prior to its issuance also i 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 Divislon 3 of the Business and Professions Code, or that. he Is exempt 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 five 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 Bnprovements 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 4nprove for the purpose of sale.) O 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 contractors) pcensed pursuant to the Contractor's License Law.) O 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 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 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. Date Owner NOTICE TO APPLICANT., ff, 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. WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL. AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. 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 Description Project Description OCC. GRP.: Serer Conneclt ZONE: BY: Minimum Setback Distances: , l+ Front Setback from Center Line Rear Setback from Rear Prop. Line +` Side Street Setback from Center LiAe Side Setback from Property Line FINAL DATE INSPECTOR Issued by: Date Permit Validated by: Validation: Sq. Ft. Size - No. Stories No. Dw. Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation $1880.00 PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. Const. $30.00 Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure TOTAL $30.00 REMARKS ZONE: BY: Minimum Setback Distances: , l+ Front Setback from Center Line Rear Setback from Rear Prop. Line +` Side Street Setback from Center LiAe Side Setback from Property Line FINAL DATE INSPECTOR Issued by: Date Permit Validated by: Validation: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBIW FEES 1 IST FL. SO. FT. ® $ UNITS SLAB GRADE ROUGH PLUMB. BONDING YARD SPKLR SYSTEM 2ND FL. SO. FT. @ FORMS < SEWE S ROUGH WIRING MOBILEHOME SVC. BAR SINK POR. SO. FT. ® GAS (ROUGH) METER LOOP GAR. SO. FT. ® POWER OUTLET ROOF DRAINS GAS (FINAL) TEMP. POLE DRAINAGE PIPING CAR P. I SO. FT. GROUT WATER HEATER WALL SO. FT. ® FINAL INSP. DRINKING FOUNTAIN SO. FT. ® WATER SYSTEM URINAL ESTIMATED CONSTRUCTION VALUATION $ WATER PIPING NOTE: Not to be used as property tax valuation FRAMING 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 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 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/. c SEWAGE DISPOSAL INSULATION/SOUND SO.FT.GAR ® 3/<c HOUSE SEWER FINISH GRADING 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 S AIR COND. SOLAR SETBACK GROUND PLUMBING UNDERGROUND A.C. UNIT COLL. AREA SLAB GRADE ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMS < SEWE S ROUGH WIRING DUCT WORK ROCK STORAGE FOUND. REINF. GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APP.IEOUIP. REINF. STEEL GAS (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM CU. yd. $ -Plus-x$-=$ LUMBER GR. /GRADING /LIN FINAL INSP. FRAMING FINAL INSP. X U 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 77 • ' COACHELLA VALLEY WATER DISTRICT r`ACEI ocrrnor ncreu Received F Address: Account N Service Ad ❑ Meter(s) ❑ Service(s) ❑ Backflow(s) ❑ House Laterals) ❑ DetectorCheck(s) ❑ Meter Surcharge 9 -Sanitation 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 M S�BCi� ,C- TOTAL $ 2 Remarks:' v ' ❑ Copy to: Cash ///p y. Water Service Check ' ��I� ti. Money I :. Cashier Order ' CVWD-438 (11 /89) r• ECONO SEWER SERVICES P.O. Box 192 PALM DESERT, CALIFORNIA 92261 00M MOM MEM 46141 PHONE 328-7760 346-2793 ✓off �-' �.5 CUSTOMER'S ORDER NO. PHONE MEC HELPER STARTING DATE TAX DATE MP TED Y RK RDERED BY TOTALAMOUN (/ � BILL T ORDER TAKEN BY MOOR ES DAY WORK E] CONTRACT CITY- EXTRA JO LOC N �MEDND . 60 rAA JOB PHONE G ION OFlWVR2YSt / PAYMENT TERMS NET 30 DAYS FROM DATE OF SERVICE 1%% PER MONTH CHARGE AFTER 30 DAYS ❑ No one home Total amount due ❑ Total billing to SIg atur above work or be mailed after completion PRO 15&1 � Inc I hereby acknowledge the satisfactory completion Of work crot n Mm 01 71, of the above described work TOTAL MATERIALS TOTALLASOR .1 rA THIS INVIBIGE N TE WILL BE MAILED TAX DATE MP TED Y RK RDERED BY TOTALAMOUN (/ � ❑ No one home Total amount due ❑ Total billing to SIg atur above work or be mailed after completion PRO 15&1 � Inc I hereby acknowledge the satisfactory completion Of work crot n Mm 01 71, of the above described work