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14248 (PLBG)I Building Address, 1;3-% Owner Dinias Mailing Address 53-844 Avenida City Zip %a Qvinta 92253 Contc Vatll.ey Plumbing Address P.00BOX, 665 City Zip Indio 92201 State Lic. & Classif. 273088 Arch., Engr., Designer Address Tel. P.O. BOX 1504 No, 78-105 CALLE ESTADO LA QUINTA, CALIFORNIA 92253 BUILDING: TYPE CONST. OCC: GRP. A.P. Number r44 Legal Description Project Description Aevex connection Tela 347--3629 City Lic. # . ,.. Tel. City I Zip I State Lic. # LICENSED CONTRACTOR'S DECLARATION I herebyy affirm that.l aam licensed underali .,visions of Chapter 9 (commencing with Section 7000) of Divisiom-Toftthe BusinessP'nd%Professions Code, and my licerlsfeaissiin u11 fort and effect. pi ! 1 SIGNATURE i �� `' • -/l DATE ^' OWNER -BUILDER DECLARATION I hereby 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,- 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 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 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). ❑ 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, asowner 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 o�donsent to self -insure, or a certificate of Worker's Compensation Insurance, or a certi Pied copy thereof. (Sec. 3800, Labor Code.) Policy No. Company SwCoopy is filed with the city. ❑ Certified copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM WORKERS' COM P ENSATIO N 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: 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 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 sof this city to enter the above-. mentioned property for inspection purposes. Signature of applicant Date Mailing Address City, State, Zip ZONE: BY: Minimum Setback Distances: r wig Front Setback from Center Line -L -l" Sq. Ft. Size No. Stories No. Dw. Units, New ❑ Add ❑ Alter ❑ Repair ❑ Demolition p FINAL DATE INSPECTOR Issued by: Date Permit Validated by: Validation: r• f ,! N Estimated Valuation 1'1'000 00 PERMIT AMOUNT Plan Chk. Dep: Plan Chk. Bal. Const. Mech. Electrical Plumbing $til, ou S.M.I. Grading Driveway Enc. Infrastructure "i TOTAL �3 REMARKS ZONE: BY: Minimum Setback Distances: r wig Front Setback from Center Line -L -l" 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. SO. FT. p $ UNITS SLAB GRADE r� BONDING YARD SPKLR SYSTEM 2ND FL. SQ. FT. ® FORMS SEWER r9R."T16�!10gl! � ROUGH WIRING MOBILEHOME SVC. BAR SINK FOR. SQ. FT. ® GAS (ROUGH) METER LOOP HEATING (FINAL) POWER OUTLET ROOF DRAINS GAR. SQ. FT. ® TEMP. POLE GROUT DRAINAGE PIPING S CAR P. O. FT. FINAL INSP. WALL SQ. FT. WATER SYSTEM DRINKING FOUNTAIN. GRADING cu. yd. $ plus x$ =$ URINAL SQ. FT. ® FINAL INSP. FRAMING ESTIMATED CONSTRUCTION VALUATION $ WATER PIPING NOTE: Not to be used as property tax valuation FLOOR DRAIN MECHANICAL FEES WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER FIRE ZONE ROOFING GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED FIREPLACE LAUNDRYTRAY 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. SQ. FT. ®c BATH TUB SQ. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SQ. FT. RESID ® 1+/a c SEWAGE DISPOSAL SQ.FT.GAR ® V4c HOUSE SEWER FINAL INSPECTION —2j -ItILO 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 S AIR COND. SOLAR SETBACK GROUND PLUMBING UNDERGROUND A.C. UNIT COLL. AREA SLAB GRADE ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMS SEWER r9R."T16�!10gl! � 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. FINAL INSP. FRAMING FINAL INSP. ROOFING REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATIONISOUND FINISH GRADING FINAL INSPECTION —2j -ItILO CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL r .. .,.•...=ilY„-�^+rSID�,�An��.!�i'!t•�`{F>,�^tn 4v.:+c+tjt•�•1•�+}•."�){'r i'�f,{:"a i..i:i�i1�'Yk, .--a�iGyP..i;,� ra+o.F�.'hy;'r. COACHELLA VALLEY WATER DISTRICT 'Y - ' CASH RECEIPT DETAIL Received F;oM: I Address: Account No. li 111- Lot(s) 1 Service Address Tract `G.A.Code t�^ 0 Meter(s) ❑ Service(s) ❑ Backflow(s) ❑ House Laterals) t ❑ Detector Check(s) ti - y ,. : i 4, , . .:. ❑ Meter Surcharge �' s ' x' ".- r Zfti. , 7 r �' a M smo"_ r q r � , ,u; anitation Capacity Charge - S` "� r•- - -� t„ c '" :d .,�� ,. ❑ W.S.B.F.C. ='t.r . e ; .: x : `, µw. - "CI, IE '[• a .: ,4 + R <iF � %1".;'1 • ❑-Temporary Construction Meter Yi.+T•�i '-• ❑ Turn on Charge j ❑ Uncollected Account -Name ❑ Inspection Fee -Tract - �, - .. 1,.� ai �. ..,Z . .,. Fee- l �`` - .t � xrY3 •'#'��,�•' "+fir ❑' Plan Check Fees Water (Sewer -+nz - ' � �� - ; ti � � . ^ � 1+ 4 "�. � • . i. 3 - •g ws'. a �� :�•�„ � �r , ti's Tract - ❑ Bond Payment - A.D. - Bond `. ray, o^,?r_✓ . ❑ Customer De osit- k i n .....�� ai r �w ❑ Other' rr �:rsTM a;-�.. s r; .. , �t' 3: �::r, r ,• , - s. s ; ' .. z �w .3a _art•,+• `r • ' , ; t -: ` ' \ - ,.TOTAL r Remarks:-. rrr-. .x _ S; 'ems �• t ❑ copy to: ; f - A, 1 i� F '� i �' s •t Y�a''!.%i ' \• :?'-. `sh(. � 1 R "{. '