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11103 (PLBG)4 P.O. BOX 1504 (l t" / N o . 11103 _73j LAQUINTACCALFORNIA92253Building{6 i33T Address , n Owner Kevin Leonhard Mailing BUILDING: TYPE CONST OCC: GRP. Address Serie' A.P. Number City Zi Tel. Quita���? 360-122 Legal Description Contractor Project Description Sewer Connection & upgrade Address 10© 'a9:f3p electric service o 200 amp City Zip Tel.. State Lic. City / & Classif. Lic. # Sq. Ft. No. No. Dw. Arch:, Engr., Sizer Stories Units Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Address Tel. $ewer -_1000 Elec 200 City Zip State ' Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing with Section effec 7000) t. of Division 3 of the Business and Professions Code, and my license is in full force and • SIGNATURE - DATE - OWNER -BUILDER DECLARATION Estimated Valuation I hereby affirm that I am exempt from the Contractor's License Law for the following a� 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 hes licensed pursuant to - PERMIT AMOUNT the provisions of the Contractor's License taw, 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 PlanChk. Dep. - subjects the applicant to a civil penalty of not more than rive hundred dollars ($500). ❑ I, as owner of the property, or my employees with wages as their sole compensation, will Plan Chk. Bal. do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and Const. 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 The not intended or offered for sale. If, however, the.building _ Mech. orimprovement is sold within one year of completion, the owner builder wig have the burden 33.51111 . of proving that he did not build or improve for the purpose of sale.) Electrical s ' .ti I, as owner of the property, am exclusively contracting with licensed contractors 4o con- Plumbing 30.00 strut[ 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 S.M.I. _ such projects with a contractor(s) licensed pursuant to therContractor's License Law.) - - - ❑ 1 am exempt under Sec. & P C or this reason Grading Driveway Enc. Date Owns'- f� _ 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 ❑ 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 it the permit is fox', t *0n e hundred dollars ($100) valuation .,(�$1 1!$? _t [i .E:`'s .fi/n-�`'' •-•L?� # f.1 or less.) gf� 1 �QSi t Pitt i!k_ i O?. iaJ I certify that in the performance of h wok for which this permit is issued, I shall not employ any person in anyfsu manner so as�to' beconiebjectto the Workers' Compensation' Laws of California. tt Date Owner i NOTICE TO APPLICAN - 1, after making this jCertificate of Exemption' you should become ZONE: BY: subject to' the Worke Compensation provisions of the Labor Code, you must forthwith Minimum Setback Distances: comply with such provisions or this permit shall be deemed revoked. Front Setback from Center Line Rear Setback from,Rear Prop. Line' CONSTRUCTION LENDING AGENCY. Side Street Setback from Center Line 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 Setback from Property Line Lender's Name Lenders Address 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 certify that I 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-. mentioned property for inspection purposes. I Validated by: Signature of applicant Date Mailing Address Validation: City, State, Zip CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING KES IST FL. SQ. FT. ® $ 2ND FL SQ. FT. ® POR. SQ. FT. ® GAR. Sp, FT. ® CARP. SQ. FT. WALL SQ. FT. ® Sp FT ® ESTIMATED CONSTRUCTION VALUATION $ UNITS MOBILEHOME SVC. POWER OUTLET YARD SPKLR SYSTEM BAR SINK ROOF DRAINS DRAINAGE PIPING DRINKING FOUNTAIN. URINAL WATER PIPING NOTE: Not to be used as property tax valuation' ROU LUMB. FLOOR DRAIN MECHANICAL FEES HEATING (ROUGH) WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) , APPLIANCE DRYER DUCT WORK GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED - LAUNDRYTRAY AIR HANDLING UNIT CFM HEATING (FINAL) 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. SQ. FT. ® c BATH TUB BOND BEAM SQ. FT. ® c WATER HEATER MAX HEATER OUTPUT, B.T.U. SQ. FT. RESID ® 11/4 c SEWAGE DISPOSAL LUMBER GR. SQ.FT.GAR ® 3/ac HOUSE SEWER FINAL INS 37iv` � / j ROOFING GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEE MECH.FEE PLCK.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 ROU LUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMS or SEWER O ROUGH WIRING. DUCT WORK ROCK STORAGE FOUND. REINF. GAS (ROUGH) / 2 (O i1 atA 6 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 3 GJ t FRAMING FINAL INS 37iv` � / j ROOFING REMARKS: VENTILATION FIRE ZONE ROOFING: FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATIONISOUND FINISH GRADING FINAL INSPECTIO CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL r ' Received Fro 4= ` 0/47 x COACHELLA VALLEY WATER DISTRICT CASH RECEIPT DETAIL 1/ 'r y N JJ $. Date: (�--�� / ��,'.' y(I �� Address: ❑Copy to: ✓•- " (` Account No. — Jr --�Lot(s)t C/ Tract // Water Service \- Money Service Address G.A. Code Order ❑ Meter(s) CND -438 (11/89) $ ❑ Service(s) ❑Ba kflow(s) ' House Laterals) ❑ DetectorCheck(s) JNeterSurcharge 0/M :• .C]/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 Remarks:(! 7 �� ❑Copy to: Cash Check Water Service \- Money Cashier Order CND -438 (11/89)