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15059 (PLBG)r tZ' • 1�Gl�Cu Yr ` ( P.O. BOX 1504 Building78-495 CALLE TAMPICO Address 51-333 Avenida Vallejo LA QUINTA, CALIFORNIA 92253 Owner -fon Weddle Mailing Address 51-133 Avenida. Vallejo City Zip Tel. La Quints 92253 •, Tri—M,ar Const�ctio' n Address P.0«Box 5$2 City Zip - Tel.: Cit City. X2234 321-0898 State Lic. City & Classif.. 47551.5 A Lic. # 762 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 .%gith Section '. 7000) of Division 3 of the Business and Professions Code, and.my license is in full force and effecL•� f F s / r SIGNATURE - 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, alter, improve, demolish; or repair any structure, prior to its issuance also requires the applicant for such permit to rile 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 penally 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, Suisness 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 knprove for the purpose of sale.) 01, 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) ticensed pursuant to the Contractor's License Law.) ❑ 1 am exempt under Sec B. & P.C. for this reason Date Owner No. 15059 BUILDING: TYPE CONST. OCC: GRP. A.P. Number Legal Description Project Description: sewer connection I Sq. Ft. No. Size - • Stories New ❑ Add ❑ Alter ❑ No. Dw Units Repair ❑ Estimated Valuation., $1200.00 I - PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal Const. Mech. " Electrical Plumbing • S.M.I. Grading Driveway Enc. Infrastructure WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a, certificate of consent to self -insure, or a certificate of Workers Compensation Insurance, or a certified copy thereof. (Sea `3800, Labor Code.) Policy No. Company ' ❑ Copy is filed with the city, ❑ Certified copy is hereby furnished: TOTAL • CERTIFICATE OF EXEMPTION FROM REMARKS WORKERS' COMPENSATION INSURANCE (This section need 'not be completed .g 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-Owne - NOTICE TO APPLICANT.- If; alter 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 Prop. Line WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL,'AND - Side Street Setback from Center Llne ' SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES -AND CIVIL FINES UP TO ONE •. HUNDRED THOUSAND DOLLARS;($100,000), IN ADDITION 70, THE COST OF COMPENSATION, Side Setback from Property Line DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR 'CODE, INTEREST, AND ATTORNEYS FEES. FINAL DATE INSPECTOR 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 certity.that 1 have read this application and state that the above information is correct. Issued by: Date Permit. 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-.' nti.oned for inspection ^ .me. property purposes. Validated by: L Signature of applicant. Date' Mailing Address Validation: I • a' City, State, ZipAPR :r 5 1995.J.; R CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBIMS FEES 1ST FL. SO. FT. ® $ UNITS SLAB GRADE ROUGH PLUMB. BONDING YARD SPKLR SYSTEM 2ND FL. SQ. FT. @ FORMS SEWS �R S ROUGH WIRING MOBILEHOME SVC. BAR SINK POR. SO. FT. ® GAS (ROUGH) METER LOOP GAR. SO. FT. ® POWER OUTLET ROOF DRAINS GAS (FINAL) TEMP. POLE DRAINAGE PIPING CAR P. SQ. FT. ® GROUT WATER HEATER WALL SQ. FT. FINAL INSP. DRINKING FOUNTAIN SO. FT. ® WATER SYSTEM URINAL ESTIMATED CONSTRUCTION VALUATION $ =$ WATER PIPING NOTE: Not to be used as property tax valuation FRAMING FLOOR DRAIN MECHANICAL FEES WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER G 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, TEMIPERM 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 ® 11/4 c SEWAGE DISPOSAL INSULATIONISOUND SO.Ff.GAR ® 3/4c HOUSE SEWER FINISH GRADING 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 SEWS �R S ROUGH WIRING DUCT WORK ROCK STORAGE FOUND. REINF. GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APP./EQUIP. REINF. STEEL GAS (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM GRADING Cu. yd. $ plus x$ =$ LUMBER GR..'"'Ow FINAL INSP. FRAMING FINAL INSP. �y !/ ROOFING REMARKS: VENTILATION G / FIRE ZONE ROOFING' FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATIONISOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL . . r A' 'Received Fro !r ` �'"� c -C 4 1:� "'4Wlhn�icY...a ,vyJ•.f-..::)N.n s- r.. •�` r « i COACHELLA VALLEY WATER DISTRICT CASH RECEIPT DETAIL i j L1 r I 1 `. Ll�� '1'('� �� . I (� • �) L�. l U i�l Address: ! �� % t �'..' ; i f 1 CZ_ S � r' 1-, t�'r -"' ''r `t L Service Address - L t(?) t u'" Tract G.A. Code ❑ Meter(s) $ ❑ Service(s) ❑ Backflow(s) House Lateral(s) ° ❑ DetectorCheck(s) ❑ Meter Surcharge Sanitation Capacity Charge - O 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 - .0 Bond Payment - A.D. - Bond Assmt. ❑ Customer Deposit + ❑ Other f O'd TOTAL $ Remarks: ❑Copy to: Cash Water Service r Check Money`r: Cashier - Order ,c- . 6VWD-438 (11/89)