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10880 (PLBG)4 P.O. BOX 1504 Building 54--940 Dias 78105 CALLE ESTADO '\ Address LA QUINTA, CALIFORNIA 92253 y Owner *BOO l rudeau BUILDING: TYPE CONST. Mailing Sewer Hook Up Address same City Zip Tel. La Quinta No. Dw. Units 92253 _ Contractor R.A. Rich Plumbi a-19 Address Box 1062 City' Zip Tel.: La Quinta 1, 200 92253 564--2605 State Lic. AMOUNT City & Classif. C36 457795 Lic. # 1960 Arch., Engr.,' Const. Designer Mech. Address Tel. City zip State Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that 1 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 aNect. SIGNATURE DATE OWNER -BUILDER DECLARATION ' I hereby affirm that I am exempt from theContractor's License Law for the following reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a permit to construct, atter, 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, Chapter9 (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). . - A 1, 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. '.n however, the building. or improvement is sold within one year of completion, the owner -builder will have the burden y . , of proving that he did not build or improve for the purpose of sale.) O I, as owner of the property, am exclusively contracting with licensed contractors to col. i struct the project. (Sec. .7044. Business and Professions Code: The Contractors 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.) fJ 1 am exempt under Sec. B. &'P.C. for this reason Date Owner a v r7 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. . Cl 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 (5100) valuation or less.) I certify that in the performance of thg work for which this permit is issued, I shall not employ anyperson in any manner so as to become subject to the Workers' Compensation Laws of California. Date Owner NOTICE TO APPLICANT. ff, 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. 7 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 Lenders Address This is a building permit when'properly filled out, signed and validated, and is subject to expiration it 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 A.P. Number No. 10880 —OCC: GRP. Legal Description Project Description Sewer Hook Up Sq. Ft. Size No. Stories No. Dw. Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation 1, 200 PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal.. Const. Mech. Electrical Plumbing 30.00 S.M.I. Grading Driveway Enc. Infrastructure TOTAL so « L U REMARKS i!,49Z 6 P7 16 c1A74 _fru--99-9'1 iYt 3,,,HeTTt � f'6t1 i$i. S 7J>,-' 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 Validated by: Validation: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SO. FT. ® $ UNITS ROUGH PLUMBBONDING 2ND FL. SO. FT. STORAGE TANK YARD SPKLR SYSTEM FOR. SO. FT. ® MOBILEHOME SVC. BAR SINK GAR. SO. FT. ® POWER OUTLET ROOF DRAINS CAR P. SO. FT. ® REINF. STEEL DRAINAGE PIPING WALL SO. FT. DRINKING FOUNTAIN. SO FT ® FINAL INSP. URINAL ESTIMATED CONSTRUCTION VALUATION $ WATER SYSTEM WATER PIPING NOTE: Not to be used as property tax valuation LUMBER GR. FLOOR DRAIN MECHANICAL FEES FINAL INSP. WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER VENTILATION 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 SO. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 11/4 c SEWAGE DISPOSAL SO.FT.GAR ® 3/ac 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 PLUMBBONDING HEATING (ROUGH) STORAGE TANK FORMS L's SEWER 0A%TMTS��M OUCH 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 CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL COACHELLA VALLEY WATER DISTRICT CASH RECEIPT DETAIL Received From: J Address: y Account No. / Lot(s i } Service Address ❑Copy to: ❑ Meter(s) Cash ❑ Service(s) WaterServlce ❑ Backflow(s) Check ❑ House Lateral (s) Cashier ❑ DetectorCheck(s) Money Order ❑M ter Surcharge ZanitationCapacityCharge G lJ ❑ W.S.B.F.C. ❑ Temporary Construction Meter ❑ Turn on Charge ❑ Uncollected Account - Name ❑ Inspection Fee - Tract - Fee - ❑ Plan Check Fees Water / Sewer - Tract - ❑ Bond Payment - A.D. - Bond Assmt. ❑ Customer Deposit ❑ Other _ TOTAL $ J Remarks: r ? : il.: ❑Copy to: Cash j �� ,.. nC'.�.• WaterServlce Check Cashier ` J Money Order CVWD-438(11/89)