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15323 (PLBG)Building Address 78-398 SINGING PALMS Owner RICHARD W, FAR IS Mailing Address 331 WESTLAR.R TERRACS CityTel. rpv-2262 PALM SPRINGS — Contractor P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Address . 77200 HINNES€ TA, City111260 Tel.: ALK DESERT. 9 77 —3100 State Lic. City & Classif.. A R 654519 Lic. # 2 578 Arch., Engr., Designer Address Tel. City (Zip (State Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) t. of Division 33fofs- , -the Businesand Professions Code, and my license=is in full foGce and effec1/ .�- a,, $LGNATURE l ` DATE OWNER -BUILDER 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, after, improve, demolish, or repair any structure, prior to its issuance also requires the applicant for such permit to rife a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law, Chapter 9 (commencing with- Section 7000) of •Divlsfon 3 of the Business and Professkms ' 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 (8500). O 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 or sale.) ❑ I, 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 contractors) ficensed pursuant to the Contractor's License Law.) O 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 ❑ Copy 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 9f„thp work for which this permit is issued,,I shall not employ any � pparson in any manner,so'as"to becslmeasubject�to-the-WorkecseCompensation Laws of�Californiar .0 '� Date ' '' 'Owner NOTICE" TO APPLICANT fl, aRei'`inakfng this Certificate of Exemption you should become subject tT: o the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or ttio permit shall be deemed revoked. WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP. TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. This is a building permit when properly filled out; signed and validated, and is subject to expiration if work thereunder is suspended for 180 days. I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances• and state laws relating to building . construction, and hereby authorize representatives of this city to enter the above- mentioned property for inspection purposes. Signature of applicant�$LF✓--.,ff�rlls�_".. ^� Date Mailing Address _- ' �► -7rr City, State, Zipr"lf No. 15323 yy 4; BUILDING: TYPE CONST: OCC: GRP. A.P. Number Legal Description Project Description SEVER HOOKUP Sq. Ft. Size - No. No. Dw. Stories . Units New ❑ Add ❑ Alter ❑ Repair Demolition C Estimated Valuation $750 PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. Const. Mech. ' Electrical Plumbing F3-107. 0 S.M.I. Grading Driveway Enc. Infrastructure TOTAL .30•i1 REMARKS ti ZONE: BY: Minimum Setback Distances: Front Setback from Center Liq� Rear Setback from Rear Pro e Side Street Setback from' er Li Side Setback from Pyop rt Line Q FINAL DATE Issued by: Date Validated Validation: 9` CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING VIES • 1ST PL. SO. FT. ® $ UNITS ~ SLAB GRADE ROUGH PLUMB. YARD SPKLR SYSTEM 2ND FL. SO. FT. HEATING (ROUGH) STORAGE TANK FORMS MOBILEHOME SVC. BAR SINK Poo, SO. FT. ® DUCT WORK ROCKSTORAGE t POWER OUTLET ROOF DRAINS GAR. SO. FT. HEATING (FINAL) OTHER APPJEOUIP: REINF. STEEL GAS (FINAL) DRAINAGE PIPING CAR P. S0. FT. ®. WALL S0. Ff. WATER HEATER DRINKING FOUNTAIN. SO. FT. ® FINAL INSP. URINAL ESTIMATED CONSTRUCTION VALUATION $ SYSTEM WATER PIPING NOTE: Not to be used as property tax valuation GRADING cu. yd. $ plus x$ FLOOR DRAIN MECHANICAL FEES �A � FINAL INSP. WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASH ER(AUTO)(DISH) APPLIANCE DRYER GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED VENTILATION LAUNDRY TRAY 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. SO. FT. ® c BATH TUB SO. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 11A c SEWAGE DISPOSAL SO.FT.GAR ® 3/ac HOUSE SEWER INSULATION/SOUND 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 R S ROUGH WIRING DUCT WORK ROCKSTORAGE FOUND. REINF. GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APPJEOUIP: REINF. STEEL GAS (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAMER SYSTEM GRADING cu. yd. $ plus x$ • =$ LUMBER GR. �A � FINAL INSP. FRAMING FINAL INSP. �� g 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 SIGNATURES/INITIALS GARDEN WALL FINAL -^...a-•�-..o•e... .... .. ---,�+�^..,3r^-�-..— ':�.Ct'a'TT'�,�^^:.Ta, .. ;�—_ ��.,---a� . S,�r••�-�"�,^-�s�-�-.�-v��..� . COACHELLA VALLEY WA ER DISTRICT. ;. '' CASH RECEIPT DETAIL Received From: y W �`'" G i/\ ( V� 3 9 5 ` �� J 'Date• Address: wF �:. �CR-t1C. �= (c' Y Yl1 CS' �t C� .� �.:1 Sry' i �a4•D AccountNo�-I -)��•1 lam% 1 • C Lot(s17 \ J Tract °� Z � n _39 - r. Service Address " v� C. (" G.A. Code ❑ Meter(s) $ ❑ Service(s) ❑ Backflow(s) ❑ House Lateral(s) ❑ DetectorCheck(s) ❑❑ Meter Surcharge . I -Sanitation CapacityCharge ❑ W.S.B.F.C. - ❑ Temporary Construction Meter ❑ Turn on Charge . ❑ Uncollected Account - Name • J . ❑ Inspection Fee - Tract - Fee - .0 Plan Check Fees Water I Sewer - Tract - ❑ Bond Payment - A.D. - Bond Assmt. ❑ Customer Deposit ❑ Other ' TOTAL $ I/•>i S U V Remarks: ❑Copy to: Cash Water Service Check Money Cashier ' Order �> UCVWD-438 (11189) JOB INVOICE (619) 321-7448 ( i t i 1. . l j i • I I JOB INVOICE (619) 321-7448 ( CUSTOMER'S ORDER NO. DATE ORDERED ORDER TAKEN BY DATE PROMISED D A.M. 0 P.M. BILL TO PHONE ADDRESS '2C {/ 7 MECF/M�\jVI 1. Cg4 VTY I' 0 1HELPER JOB NAME AND�1T�' 78-3LOCATION r `( � � /4. (.�1s L� 0 DAY WORK DESCRIPTION WORK - K/ +(� C/L t �e. l i'L / Gt"�, (`. �Ci ✓� ❑ CONTRACT ❑ EXTRA • QUANT. DESCRIPTION OF MATERIAL USED PRICE AMOUNT lOOo Gallons /G 80 Pumping Fee per 1000 gal. 010 (OOC Dumping Fee per 1000 gal. j K 5—o �� , —6 a� Out of Area Fee Locating / Opening Fee (per hour) r� Size System'. "'rX6&-( . A SERVICE CHARGE OF $20 WILL BE DUE ON ALL RETURNED CHECKS. A FINANCE CHARGE OF 11/2% PER MONTH, 18% PER YEAR WILL BE CHARGED ON PAST DUE ACCOUNTS OVER 30 DAYS. HOURS LABOR AMOUNT TOTAL MATERIALS MECHANICS @ HELPERS TOTAL LABOR I hereby acknowledge the satisfactory TOTAL LABOR completion of the above described work: TAX SIGNATURE DATE COMPLETED