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11559 (PLBG)44 P.O. BOX 1504 No* Building 78-105 CALLE ESTADO D Address 54-16.5 JuarezLA QUINTA, CALIFORNIA 92253 ` L-�% Owner �� Bryan Elsner Mailing Address 74-2.25 111 City Zip Tel. Palm Desert- 92260 Contractor 74-225 Hwv 211 City Zip Tel.: Paha Desert 92260. 568-0855 State Lic. City & Classif. 56581-4, Lic. # 2001 Arch., Engr., Designer Address Tel. City ( Zip ( State Lic. # „LICENSED CONTRACTOR'S DECLARATION I hereby affirm thabl am licengperander provisions of Chapter 9 (commencing with Section 7000) of Division -3 of the Busirnr€ss:and /Ptofessions Code, and my'license is in full force and effect. W - ill . /' 4,4 .../ 1GNATURE / —k -fl V �. / ..s L." !.ice" DATE ' OWNEVBUIL'DER DECLARATION 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, atter, 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 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 thealleged 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 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 of property -who builds or improves thereon, and who. contracts for such projects with a contractor(s) licensed 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's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.) Policy No: Company OyCopy 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 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. CONSTRUCTION LENDING AGENCY Ihereby 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 it 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 11559 BUILDING: TYPE CONST. OCC: GRP.- A.P. Number Legal Description Project Description Sever Connect REMARKS ZONE: BY: Minimum Setback Distances: Sq. Ft. No. Size Stories No. Dw. Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Side Street Setback from Center Line Side Setback from Property Line FINAL DATE INSPECTOR Issued by: Date Permit Validated by: Estimated Valuation Validation: 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: 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: Validation: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SQ. FT. ® $ 2ND FL. SQ. FT. POR. SQ. FT. ® GAR. Sp. FT, ® CARP. SQ. FT. WALL SO. FT. ® Sp 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 FLOOR DRAIN MECHANICAL FEES HEATING (ROUGH) WATER SOFTENER VENT SYSTEM FAN EVAP.000L HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER DUCT WORK GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED LAUNDRY TRAY AIR HANDLING UNIT CFM HEATING (FINAL) 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. SQ. FT. ® c BATH TUB BOND BEAM SQ. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 1% c SEWAGE DISPOSAL LUMBER GR. SQ.FT.GAR ® 3/ic HOUSE SEWER FRAMING FINAL INSP. 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 -0fh9EP9'l6.ZpNl(C� %ROUGH WIRING. DUCT WORK ROCK STORAGE FOUND. REINF. GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APP./EOUIP. 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 L L CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURES/INITIALS GARDEN WALL FINAL /! r / L /+ Received From: CC-` / %C 7 % .�.. A COACHELLA VALLEY WATER DISTRICT CASH RECEIPT DETAIL 1 L � / �``` J . - �3 — = ..v CIIS r; �y � � -� Date: A ! '�✓. _ 11 t Address: f �. 7 C_ 6, ?"t �i/� 5%'w .. '�! �'w �..'�_ 'i>••_t l c. Account No.� Lots) Tract ��z'.: Service Address � e_ •• tt i (.1 A t -'_S 'Z- Ic_ G.A. Code Orden ❑ Meter(s) $ ❑ Service(s) ❑ Backflow(s) ❑ House Lateral(s) ❑ DetectorCheck(s) . ❑ Meet�,�te'r.Surcharge Q.�anitation Capacity Charge i ❑ W.S.B.F.C. . ❑ Temporary Construction Meter • ❑ Turn on Charge ❑ Uncollected Account -Name ❑ Inspection Fee - Tract - Fee - ❑ Plan Check Fees Water / Sewer - Tract - ❑ Bond Payment - A.D. - Bond Assmt. ❑ Customer Deposit ❑ Other TOTAL $ Remarks: ❑Copy to: Cash Check ) 197 Money Orden Water Service I� 1 ri Cashier CVWD-4 1 -r:,C 38(1 89)