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14374 (PLBG)4 P.O. BOX 1504 No. 1,4374 Building' 46- 325 Roadrunner 78-495 CALLE TAMPICO Address LA OUINTA, CALIFORNIA 92253 Owner Lat ry & Barbara L€:thGGC3 Mailing BUILDING: TYPE CONST. • OCC: GRP. Address Same A.P. Number l City Zip Tel. La :Q:uinta-, -CA . .9-1253 .. Legal Description ContractorProject Description Sewer Connect" Aro 'Hok 255 %.'I.ECi' Desert, i�p 92260 T��5--6718 State Lic. A 310813 City 82 & Classif. Lic. # Sq. Ft. No. No. Dw. Arch'., Engr.,' Size- Stories. Units Designer New ❑ Add ❑ Alter ❑ Repair.❑ Demolition ❑ Address Tel. City Zip State Lic. # ' LICENSED CONTRACTOR'S DECLARATION 1 hereby affirm that,l,am licensed under provisions of Chapter 9 (commencing with Section /000) of Division 3.of the Business and Professions Code,'and my license is in fullforce and effect. SIGNATURE DATE ' OWNER -BUILDER DECLARATION ' : Estimated Valuation $1,700.00 I hereby affirm that I am exempt from the Contractor's License Law for the following reason: .(Sec. 7031.5,Business and .Professions Code: Any • city or. county which requires a permit to construct, alter, 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 licensedpursuant to. - PERMIT . AMOUNT the provlsions• of the Contractor's License Law, Chapter 9 . (commencing with Section 7000) of Division 3 of the Business and Professions Code, or Mat..he is exempt therefrom, and the basis - .. .. - for the alleged exemption. Any •violation of Section 7031.5 by 'any applicant for a permit Plan Cfik. Dep. . "subjects the applicant to a civil penalty or not more than rove hundred dollars ($500).• O 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 or offered 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. 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 Electrical ' . of proving that he did not build or improve for the purpose of sale.) O 1, as owner of the property, am exclusively contracting with licensed contractors to con-. Plumbing 30.00 struct the project. (Sec. 7044, Business and.Professions Code: -The Contractor's License Law does not apply to an owner of property who bullds'or Improves thereon, and who contracts for S.M.1. - such projects with a contractors) Vicensed pursuant to the Contractor's License Law.) . - - Grading O 1 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,bf„consent to self -insure, or a certificate of Worker's Compensation Insurance, or a certjfied'copy,thereof.(Sec. 3800, Labor Code.). Policy No,/- Company''_ " :f`,_ , _41_ ,—'•'"_'..... .. CiWeopy is filed with the city.. .(3 Certified cony is,hereb'y furnished. F1 /' TOTAL CERTIFICATE O EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed tf thepermit is for one hundred dollars.($100) valuation orless.) - I certify that in the performance of thg work for which this permit is issued; I shall not employ any pperson in any manner so as to become subject to the Workers' Compensation Laws of California Dt ' REMARKS a .—Owner - NOTICE TO APPLICANT: It, after making this Certificate of Exemption, you. should become - ZONE: - BY: - - subject to the Workers' Compensation provisions of- the Labor Code,' you must• forthwith comply with such provisions or this permit shall be deemed revoked. ' - Minimum Setback Distances: - Front -Setback from Center Line Rear Setback from Rear PropA`jh ' WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND-, - Side Street Setback" from C2 / Lin ' SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES. UP TO ONE HUNDRED THOUSAND DOLLARS IN ADDITION THE COST OF COMPENSATION, - ($100,000), TO Side Setback from Property e DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR'CODE, INTEREST, AND ATTORNEY'S FEES. Tnis"is a buildingFINAL permit when properly filled out, signed and validated, and is subject to DATE INSPFI OR expiration it work thereunder is.suspended for 180 days. I certify that I' have read this application and state that the above information is correct.. ISSUed by: n r, Date GTi. Aefml , 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: L 74 Signature of applicant Date Mailing Address Validation: City, State, Zip `- - \ CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBIW FEES 1ST FL. SO. FT. ® $ 2ND FL. SO. FT. ® POR. SO. FT. ® GAR. SO. FT. ® CAR P. SQ. FT. WALL SQ. FT. ® SQ. 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 BONDING FLOOR DRAIN MECHANICAL FEES FORMS WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER GAS (ROUGH) GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED OTHER APPJEQUIP. LAUNDRY TRAY AIR HANDLING UNIT CFM TEMP. POLE 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 FINAL INSP. SO. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 114 c SEWAGE DISPOSAL SO.FT.GAR ® 3/ac HOUSE SEWER VENTILATION 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 SEWER OR 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 INSULATION/SOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL 1� C.OACHELLA VALLEY WATER DISTRICT �1 1 CASH RECEIPT DETAIL •GyE7N�r /)!?n / i fill. F./ r;%/� ✓bate Received From: 1 Address: _/• �Trait .� �. h -7I Account No. a� 1 �f l 5- = Lot(s) Z' Service Address C - !`- G.A. Code S ❑ Meter(s) ❑ Service(s) ❑ Bapkflow(s) ouseLateral(s) ❑ Detector Check(S) ❑ Meter Surcharge ' C; o.=+ Sanitation Capacity Charge P ❑ W.S.B.F.C. ❑ Temporary Construction Meter ❑ Tum on Charge ❑ Uncollected Account- Name ❑ Inspection Fee - Tract - Fee- ❑ Plan Check Fees Water I Sewer - Tract - ❑ Bond Payment - A.O. -_Bond ❑ Customer Deposit ❑ Other TOTAL E 7 ^• Remarks: C) copy to: Water Service t h ,/ 'v ck 1 -! Tj, ///```�� ` Cashier X-ney f j '.1 �• ovwD-a3a(tve9)