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10772 (PLBG)r Building'' Address 54-230 VELASCO Owner MIKE POLK P.O. BOX 1504 N o . 10 772 78-105 CALLE ESTADO LA QUINTA, CALIFORNIA 92253 maning Address CAHE City Zip Tel. .LA.QUINTA 92253 1346-6355 Contractor OWNER BUILDER Address. . SAME City . Zip Tel.: BUILDING: TYPE CONST. . OCC: GRP. Number Legal Description Project Description SEWER HOOKUP State Lic. City & Classif. Lic. # Sq. Ft. No. No. Dw. ' Arch., Engr., Size • . • - Stories - Units Designer New ❑ Add ❑ Alter ❑ Repair ❑ -Demolition ❑ Address Tel. City Zip State ' r Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. SIGNATURE DATE ' OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following Estimated -Valuation $200.100 reason: (Sec. 7031.5,Susiness 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 he4s licensed pursuant to PERMIT AMOUNT 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 .Plan Chk. Dep. -'subjects the applicant to a civil penalty of.notmore than five hundred doflars.(E500). Plan Chk. Bal. 8 t' 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 Const. - builds or improves thereon and who does such work himself or through his own employees. MEich. 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:) O 1, as owner of.the property, am exclusively contracting with licensed contractors to con-: Plumbing 430.00 struct the project. (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner or property who builds or Improves thereon, and who contracts for S. M. 1. such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) Grading ' O I am exempt under Sec. B. & P.C.- for this reason Driveway Enc. Date mrd; => Owners dti�`" Infrastructure 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.) _�3 _ Policy No. - Company h6 . t t.,"1D�,5ir a3 c. 4-t^tS�-P'iai?�� [i , L'. t �� ti0..mli , O Copy is filed with the city. ❑Certified copy is hereby. furnished. TOTAL Q30.00 CERTIFICATE OF EXEMPTION FROM WORKERS'COMPENSATIONINSURANCE- REMARKS (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: It, 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 -of 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: 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 t. Validated by: Validation: 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. ® MOBILEHOMESVC. BAR SINK GAR. SQ. FT. ® POWER OUTLET ROOF DRAINS CAR P. SQ. FT. GAS (ROUGH) DRAINAGE PIPING WALL SO. FT. OTHER APPJEQUIP. DRINKING FOUNTAIN. SO 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,TEM/PERM LAVATORY HEATING SYSTEM FORCED GRAVITY AMPERES SERV ENT SHOWER BOILER. B.T.U. SO. FT. ® c BATH TUB SQ. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SQ. FT. RESID ® 1Y. C SEWAGE DISPOSAL GAR. FIREWALL SQ.FT.GAR ® V 4c HOUSE SEWER LATHING 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 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 L CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL 71 .....^r+„�+r�'�•^�.vet..,.µ;�r_'irHi!'�a�n'�'+!`e'r17ba+,,.,. �...^:,.r47•�~..rr'L'�-�� .ar^liV1r++�.r?:ru"Y'- �c+rr �il;.r.r^'�:lye`$�htir.1H'R""�Fsr+'�ltl:tv�r'�Nr•Yds'�'4..*'��E�i,r"=}'„l+e+'�`y„rrV.4�'�'I`�y'; ,r COACHELLA VALLEY WATER DISTRICT <, CASH RECEIPT DETAIL S•�a't Sq $ -7 Q , Received From: �� ¢�A ®/L��j ` . 't —Date:r • — / Address: 53 11,1.7iC,A, q ZZ -53 AccountNo. 061��6STract G� Service Address S- AV(;., VCI-Asco G.A. Code ❑ Meter(s) ❑ Service(s) ❑ Backflow(s) ❑ House Lateral(s) ❑ Detector Check(s) ❑ Meter Surcharge q/ anitation Capacity Charge ❑ W.S.B.F.C. ❑ Temporary Construction Meter ❑ Turn on Charge ❑ Uncollected Account - Name ❑ Inspection Fee - Tract - Fee - ❑ Plan Check Fees Water I Sewer - Tract - El Bond Payment - A.D. - Bond Assmt. ❑ Customer Deposit ❑ Other Remarks: ❑Copy to: Cash Check j Money Order I L L_ Water Service �.; Cashier '?.'� CVWD-438(1 189)