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11303 (PLBG)P.O. BOX 1504 N o . 11303 Buildin7&105 CALLE ESTADO t g Address 54-295 . Ramirez LA QUINTA, CALIFORNIA 92253 Owner Rtitt7 E. Willis Mailing BUILDING: TYPE CONST. OCC: GRP. Address 3909 Riche Rd X19 A.P. Number City Zip Tel. u a l lbroo 92028 Legal Description Contractor Project Description R Stevenson/RAS P lumbi ing Address Hook UD P. 0. Box 692 v Rancho Miragel­' 92270 State Lic. & Classif. Cab 602396 Arch., Engr., Designer Address 341-6546 Lic. # 2328 el. City Zip State Lica # LlUrMoru W N r r1AG FV w -S ULGLNNA 1 wN I hereby a4ffirm thafl►am�icenseiLunder provisions of Chapter 9 (commencing with Section D00) of rvision�16 the BuslnessJand;Pyofessior1s Code, and my license is in full -force and Sq. Ft. No. No. Dw. Size Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ OWNER -BUILDER DECLARATION Estimated ValUatl I hereby affirm that 1 am exempt from the Contractor's License Law for the following the, reason: (Sec. 7031.5,13usiness and Professions Code: Any city or county which , a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance also . requires the applicant for such permit to rile 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 of the Business and Professions Code, or that: he is exempt therefrom,- and -the basis for the Any Section 7031.5 for Plan Chk. Dep. alleged exemption. violation of by Any applicant a permit. subjects the applicant to a civil penalty of not more than rive 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 Const. 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 -budder 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 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 S.M.I. such projects with a contractor(s) licensed pursuant lo•the Contractor's License Law.) - Grading ❑ I am exempt under Sec. B. 8 P.C: for this reason Driveway Enc. Date owner Infrastructure WORKERS' COMPENSATION DECLARATION I heireby affirm that.I have a certificate of consent to self -insure, or a certificate of Worker's Compensation. Insurance, ora certified copy thereof. (Sec. 3800,.Labor Code.). Policy No. ' Company ' O Copy is filed with the city. 0 Certified copy is hereby fumished. TOTAL CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE. (This section need not be completed if the permit is one h�relf furs ($100) valuation or less.) N. I certify that in the performance oo�th;� ork for Whig thrs.pe0. is issuednshall not employ any person in any manner o as io• me sutSjct t1lo th�ejrWorkers'Compensation DateLaws of California. Owner ! r I J. % �Z l Qi1 ' 0 ) r NOTICE TO APPLICANT d, a(terimakin"g this Ce ti irca2101/6110f' f /Exemp "'n"`--`" yo���JJJ"' sh6uld beba e subject to the' Workers" Compensatiorr provisions of a Labor Code, .you must . forthwith comply with such provisions or this permit shaft 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. 3097, 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 abovew. mentioned property for inspection purposes. Signature of applicant Date Mailing Address City, State, Zip 1,050 AMOUNT 30.00 REMARKS isr.r.. �%C: MK - .vrw1.� :, x �...., X1 - 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 INSPECTOR Issued by; Date Permit Validated by: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES IST FL. SO. FT. ® $ UNITS SLAB GRADE 2ND FL. SQ. FT. BONDING YARD SPKLR SYSTEM POR. SQ. FT. ® MOBILEHOME SVC. BAR SINK GAR. SQ. FT. ® POWER OUTLET ROOF DRAINS CAR P. I SQ. FT. GAS (ROUGH) DRAINAGE PIPING WALL SQ. FT. OTHER APPJEQUIP. DRINKING FOUNTAIN. SQ FT ® TEMP. POLE URINAL ESTIMATED CONSTRUCTION VALUATION $ GROUT. WATER PIPING NOTE: Not to be used as property tax valuation FINAL INSP. FLOOR DRAIN MECHANICAL FEES WATER SYSTEM WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) , APPLIANCE DRYER FINAL INSP. GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED LAUNDRYTRAY AIR HANDLING UNIT CFM KITCHEN SINK ABSORPTION SYSTEM B.T.U. TEMP USE PERMIT SVC WATER CLOSET' COMPRESSOR HP POLE,TEMIPERM LAVATORY i 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. SQ. FT. RESID ® 1 Vi c SEWAGE DISPOSAL GAR. FIREWALL SQ.FT.GAR ® 7/ic HOUSE SEWER LATHING GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEE MECH.FEE PLCK.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 SEWER eM-3?P?Pe-T*NK4j 11 ROUGH WIRING. DUCT WORK ROCK STORAGE FOUND. REINF. GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APPJEQUIP. 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 INSULATIONISOUND FINISH GRADING FINAL INSPECTION G L CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS ' GARDEN WALL FINAL COACH ELLA VALLEY WATER DISTRICT CASH RECEIPT DETAIL Received'From: Addres ' IV AccounYNo. tots = / Service Address42 no ❑ ' Meter(s) ❑ Service(s) ❑ Backflow(s) ❑ House Lateral(s) ❑ .DetectorCheck(s) ❑ Meter Surcharge Sanitation Capacity Charge .� ❑ W.S.B.F.C. . .. ❑ Temporary Construction Meter ❑ Turn on Charge ❑ Uncollected Account -Name ❑ Inspection Fee - Tract - Fee - ❑ Plan Check Fees'WaterI Sewer - Tract - ❑ Bond Payment- A.D. - Bond Assmt. ' ❑ Customer Deposit ❑ Other Remarks: L l ❑Copy to: G.A. 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