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11076 (PLBG)Buildin Address 54555 Vallejo P.O. BOX 1504 78-105 CALLE ESTADO LA QUINTA, CALIFORNIA 92253 No. 11076 _jf chi. Phillips BUILDING: TYPE CONST. A.P. Number Legal Description OCC: GRP. Mailing Address same City JLa Quinta Zip 92253 JTel_ Project Description Sewer Hook Up ContrHa r Hammer Sewer Construction Address. P. 0.ic� Safi City Cat City Zip 92234 Tel.: 321-7448. State Lic. City & Classif. 41Q27� Lic. # 1238 Sq. Ft. No. No. Dw. Size Stories Units Arch., Engr., Designer New ❑ Add ❑ Alter ❑ Repair ❑ 'Demolition ❑ Address Tel. City Zip State Lic. # LICENSED CONTRACTOR'S DECLARATION I,,hereby affirm that I amllicensed under provisions of Chapter 9 (commencing with Section 700p)�o^fDivision 3 of We Business anclj (rofessions Code, and my license is in full force and' effec .w! X �� Y.'I�af✓d'VE�/`"`.,� Cy— / � '���'�"' SIGNATURE DATE OWNER -BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractor's License Law forthe following reason: • (Sec. 7031.5,Business and Professions Code: Any city or county which requires a Estimated.Valuation. 1,700 PERMIT AMOUNT ' 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 penalty of not more than rive hundred dollars.($500). O I, as owner of the property, or my, employees with wages as their sole compensation, will Plan Chk. Dep. Plan Chk. Bal. Const. do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and 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.) . Mech. ' Electrical - , Plumbing 3Q �j(j ❑ 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.) O I am exempt under Sec. B. & P.C. for this reason S.M.1. Grading Driveway Enc. Date Owner 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.) Policy No. Company O.Copy Is filed with the city. . ❑ Certified copy is hereby furnished. TOTAL 30 . {iii CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE REMARKS (This section need not be completed if the permit is for one hundred dollars ($100) valuation or less. J 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 a r r ria r x a r cy r rrr_ rw , vw 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. ZONE: BY: Minimum Setback Distances: Front Setback from Center Line Rear Setback from Rear Prop. Line 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.) Side Street Setback from Center Line Side Setback from Property Line Lender's Name Lenders 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. FINAL DATE INSPECTOR 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. Issued by: Validated by: Date Permit y Signature of applicant Date ' Mailing Address Validation: City, State, Zip CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SQ. FT. ® $ UNITS COLL. AREA 2ND FL. SO. FT. YARD SPKLR SYSTEM POR. SQ. FT. ® MOBILEHOME SVC. BAR SINK GAR. SQ. FT. ® POWER OUTLET ROOF DRAINS CARP. SQ. FT. DUCT WORK DRAINAGE PIPING WALL SQ. FT. DRINKING FOUNTAIN. SQ FT ® HEATING (FINAL) URINAL 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 GARBAGE DISPOSAL FURNACE UNIT. WALL FLOOR SUSPENDED GRADING cu. yd. $ -Plus-x$-=$ 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 SQ. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 11/4 c SEWAGE DISPOSAL FIREPLACE SQ.FT.GAR ® V4c HOUSE SEWER SPARK ARRESTOR 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 UGH 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 INSULATION/SOUND FINISH GRADING FINAL INSPECTION L �� CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURE311NITIALS GARDEN WALL FINAL I{ ' Received From: _ .1 f ' COACHELLA VALLEY WATER DISTRICT CASH RECEIPT DETAIL y 'i ' �g Date: Address: i - 1' �� �; - '` i ' Account No. l rr. L =' — �� ot(s) Tract Service Address:7 �- °' 'C - . �. '� t..1/ G.A. Code ❑ Meter(s) _ $ ❑ Service(s) ❑ Backflow(s) • ❑ House Lateral (s) ' ❑ DetectorCheck(s) ❑ Meter Surcharge U --Sanitation 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 - ❑ Bond Payment - A.D. - Bond Assmt. ❑ Customer Deposit ❑ Other TOTAL $ Remarks: ❑Copy to: ' Cash ' Check - Water Service 'Money 4, Cashier Order _ 6Vw6-438 (11/89)