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15542 (PLBG)r Building Address Owner Mailing Address 53-102 Ave. '%'-arranza monfric Same P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 City Zip Tel. La Qui.nta, CA 92253 352-9632 Contractor Econ Sewer Service Inc. Address P.O. Bax 192 Palm, Desert, gAA'92260 State Lic. Classif.. C-42 480961 & Tel: 346-2793 No. 15542 BUILDING: TYPE CONST. OCC. GRP. Number Legal Description Project Description Saw€ r Connect Payment of sewer connect fees varifie.d with C.V.W.D. ulty Lic. # 342 Sq. Ft. Size Designer I Address Tel. Cit Zi State y p 4 / Lic. # , / i%, ' LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7Q00).of Division'3 ofxthe Business and Professions Code, and my license i, /I full force and— ,1$LGNATURE ! T �� DATE jr OWNER -BUILDER DECLARATION r r Iilhereby.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, after, improve, demolish, or repair any structure, prior to its issuance also requires the applicant for such permit to file a signed statement that he Is licensed pursuant to the provisions or the Contractor's License Law, Chapter 9 (commencing with Section 7000) or Division 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). ❑ 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 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 of proving that he did not build or improve for the purpose or 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) Lcensed 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 Workers Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.) Policy No. Company EL.Copy s filed with the city. ❑ Certified copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (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 thg 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: It, 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 ateMailing Address City, State, Zip No. Stories No. Dw. Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation $1,000.00 PERMIT Plan Chk. Del: Plan Chk. Bal. Const. Mech. Electrical Plumbing S.M.I. Driveway Enc. Infrastructure TOTAL REMARKS AMOUNT 30.00 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 -issued by: Validated by: INSPECTOR -1QU v 2 1r9`y� I CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBIW FEES IST FL. SO. FT. ® $ UNITS SLAB GRADE ROUGH PLUMB. BONDING Y ; ARD SPKLR SYSTEM 2ND FL. SO. FT. p FORMS C SEWE R S L 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. SD. FT. GROUT WATER HEATER WALL SO. FT. FINAL INSP. DRINKING FOUNTAIN. BOND BEAM WATER SYSTEM URINAL SO. FT. ® ., _$ LUMBER GR. ESTIMATED CONSTRUCTION VALUATION $ FRAMING WATER PIPING NOTE: Not to be used as property tax valuation FLOOR DRAIN MECHANICAL FEES REMARKS: WATER SOFTENER VENT SYSTEM FAN EVAP.000L 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, TEMIPERM LAVATORY HEATING SYSTEM FORCED GRAVITY AMPERES SERV ENT SHOWER BOILER B.T.U. SO. FT. ® c BATH TUE MESH SO. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID Cd 1'A c SEWAGE DISPOSAL FINISH GRADING SO.FT.GAR ® 3/ac HOUSE SEWER FINAL INSPECTION GAS PIPING PERMIT FEE CERT. OCC. PERMIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEE MECH.FEE PL.CK.FEE CONST. FEE ELECT. FEE SMI F=E 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 C SEWE R S L ROUGH 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. �/ (� f%s FINAL INSP. FRAMING FINAL INSP./ Q—%. , i 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 SIONATURESIINITIALS GARDEN WALL FINAL I ECONO SEWER SERVICES P.O.. Box 192 PALM DESERT. CALIFORNIA 92261 JIM MOROaMEM Um PHONE 328-7760 346-2793 -DAZTE' F ORDER CUSTOMER'S ORDER NO. PHONE ME IC H PER STARTING DATE DATE COMPLETED WORK ORDERED BY TOTALAMOUNT $ BILL TO ORDER TAKEN BY ADDRESS DAY WORK CONTRACT CITY EXTRA JOB ND LOCA 04J JOB PHONE _PAYMENT TERMS NET lA DAYS FROM DATE OF SERVICE 1%% PER MONTH CHARGE AFTER 30 DAYS 3 :I U No one home U Total amount due U�tal billing to Signature for above work: or be mailed after PRGOIICI 258-2NEes 1.I hereby acknowledge the satisfactory completion on of work G.W Nm 01471. 0 of the above described work TOTAL MATERIALS TOTAL LABOR PLEASE PAY FROM THIS NO STATEMENT WILL BE MAILED TAX DATE COMPLETED WORK ORDERED BY TOTALAMOUNT $ U No one home U Total amount due U�tal billing to Signature for above work: or be mailed after PRGOIICI 258-2NEes 1.I hereby acknowledge the satisfactory completion on of work G.W Nm 01471. 0 of the above described work