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15541 (PLBG)�4 Building Address 4 P.O. BOX 1504 78-495 CALLE TAMPICO 52-185 Ave. R&'2mirez LA QUINTA, CALIFORNIA 92253 vWllwi Gilbert )Sclrrajas Mailing saltie Address CityZip Tel. La I ainta, 9225_ Contractor Dateland Construction Address 50-305 HWY 111 CityCoachella, CA zip 92236 Te398-5544 &tClassif. C42 396698 Lemic # 31 Arch., Engr., Designer Address Tel. City IZip I State Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 000)Div'ision of he Busin.@Us)�/�and✓Prosfe�sssionls�Code, and my license is in full force and effect. p.X_/, V._jbtraAiF' l:a�sv�gc�All lAr(-es^�•�,_ SIGNATURE ,Wa DATE OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason: (Sec. 7031.5,Busi7ess 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 We 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 or 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 rive 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 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 or property who builds or improves thereon, and who contracts for such projects with a contractors) [rcensed 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 Worker'sCc i5ensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.) Policy 1, . Company �jrCapy is 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 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: If, after making this Certificate or 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 No. 15541 BUILDING: TYPE CONST. OCC: GRP.: P. Number . Legal Description Project Description Se14er Connect Sq. Ft. No: No. Dw. Size Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ r Estimated Valuation $2,000.00 PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. Const. Mech. Electrical Plumbing ' S.M.I. Grading Driveway Enc. Infrastructure TOTAL REMARKS ZONE: BY: Minimum Setback Distances: Front Setback from Center Line Rear Setback from Rear j p. 'Line Side Street Setback froin,Center Line Side Setback from:P,roperty Line�c'`i / FINAL DATE Issued by- Date_ Validated by: Validati x CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBINU FEES 1ST FL. SO. FT. ® $ UNITS SLAB GRADE 2ND FL. SO. FT. BONDING YARD SPKLR SYSTEM STORAGE TANK MOBILEHOME SVC. BAR SINK POR. SO. FT. ® DUCT WORK ROCK STORAGE GAR. SO. FT. ® POWER OUTLET ROOF DRAINS HEATING (FINAL) OTHER APP.IEOUIP. DRAINAGE PIPING CAR P. SO. FT. TEMP. POLE WALL SO. FT. GROUT DRINKING FOUNTAIN. SO. FT. ® FINAL INSP. URINAL ESTIMATED CONSTRUCTION VALUATION $ WATER SYSTEM WATER PIPING NOTE: Not to be used as property tax valuation _$ FLOOR DRAIN MECHANICAL FEES FRAMING WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER REMARKS: GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED LAUNDRYTRAY AIR HANDLING UNIT CFM I IKITCHEN 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 ® 1Ya c SEWAGE DISPOSAL SO.FT.GAR ® 3/ac HOUSE SEWER INSULATION/SOUND 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 R 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 GRADING CU. yd. $ plus x$ _$ LUMBER GR. �y p FINAL INSP. FRAMING FINAL INSP.vj�� r O 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 DISTFUCT CAS�H RECEIPT DETAIL 54141 Received F Date Address: lks_,(io9 -et-t-, 44 Accountl,lo.&e t1ol-14 Lot(s) Trac, ServiceAddress G.A. Code 0 Meter(s) 0 Service(s) 0 Backf!ow(s) 0 House La4ral(s) 0 Detector Check(s) MeterSurcharge Sanitation Capacity Charge if) 0 W.S.B.F.C. b Temporary Construction Meter 0 Turn on Charge 0 Uncollected Account - Islame 0 Inspection Fee - Tract - Fee - 0 Plan Check Fees Water I Sewer - Tract - • Bond Payment - A.D. -'-Bond Assmt • CustomerDeposit • Other TOTAL S Remarks: • COPY to: Cash Water Serv� Check .4, Money Ord Cashier CVWD-43801189) P. E HAIMMER PUMPI,�rlft­-` JIVINVOI P.0 t 'WHEDRAL CITY, CALIFORNV-42-28 4&-j,. QUANT. OE,§CPIPTIONI.OF J4�0 (619) 360-7448 ItUpo (619021 7 48, AMOUNT. ED '�allons' 74. Pumping Fee per 1000.gaL. ORDEW,FA"N_',8.Yi,�, I§EEi- C1 A.M. P.M,' BILL TO Ile— 0(') Dumping Fee per 1000 gal, ADDRE.-' CITY A HELOER JOrX& ANr K DESCRIPTIOX6WORK c - RW- 0 V j. S ize S ystem: QUANT. OE,§CPIPTIONI.OF J4�0 PRICE AMOUNT. P-06 '�allons' 74. Pumping Fee per 1000.gaL. 0(') Dumping Fee per 1000 gal, Out of Area Fee h IrY., Locating /.Opening'Fee '�r ou. 7 V S ize S ystem: A) P ME 0 A SERVICE dHARGE1OF $20 WILL BE DUE - . 6NAILLRETURNED' CHECKS. A FINANC . E CHARG E OF'wl"/2% PER MONTH; 18% PER YEAR WILL BE CHARGED'ON PAtT,DUE ACCOUNTS OVER -30 D S., HOURS ..AMOUNT To tTALES KAT MECHANICS TOTAL LABOR HELPERS @ A I herebygknowlefle the t. aetory AL LABOR c r% complep o of the .4 ove. dx i d WOI;�--\ TAX* SIC44ATURb. DATE COMPLETV TOTAL '3 _5 Under ike �alif ornia Mechanics Lien Law any- contractor, subcontractor, J�borer, lapplier or ot.her person who helps to improve your property, but is not paid for his/bet work or supoiis, has a --right to.ent.6rce a claim against your property. This, means tl�at ifter a court hearing, your property could'be sold by a court off icer -and the proceeds of the sale used to sati , sfy thL-, , ndebt6dness. This can happen even if you have paid your contrdctor in full if the subcontract.ors, laborers or suppliers remain unpaid. To preserve their right to file'a.claim or lien against your property, certain claimants such as subcontractors or material suppliers are required to provide yoki with a document entitled "Prel,iminary Notice." Original (or prime) contractors and laborers for wages do not have to provIde this notice. A Preliminary Notice is not a lien against your propefti. Its PuroQsd is to notity, you of rersons who may hAve-a right to file a lien against your property if they are riot paid. Generally, the maximum time allowed for filing a claim or lien against your property is ninety (90) Dhvr after c6rnpletion-of your project, TO IN -SURE EXTRA PROTECTION FOR YOURSELF AND YOUR PROPERTY, YOU MAY WI$H TO TAKE ONE OR MORE OF THE FOLLOWING STEPS: 1) Require that payments be made directly to subcontractors and material suppliers through _a ji�nt..control. Any"joint control a . greement-should4riclude the addendum approved by the FtodigirAr of contractors. 2) Issue joint checks for payment, made ou�-,'tq both your contractor -and subcontractors or material suppliers involved in the project. This'vvill help to insure that all persons due payment are actually paid. 3) After UP.()N.making paynient on any completed phase of the project, and before making any farther payments, require e your contractor to provid you with unconditional lien releases signed by each material supplier, subcontractor and taborer involved in that portion -4T­i6w-- work for which payment was -,made. on. projects'Involving improvements to a single family residence or 'a duplex. owned by individuals, the persons signing. these. releases lose the right to file a'claim against your property.1notheiltypes of construction this protection may still be important,. but may not be as complete. TO PROTECT YOUF ' I$ELF UNDER:THIS 'OPTION YOU .MUST SECERTAIN THAT ALL MATERIAL SUPPLIERt,-A 6��' ' ).4ZONTRAPTORS OR,LABORERS. HAVE SIGNED.' 7.