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10840 (PLBG)Building Address 53-920 .VILLA Owner HAROLD,' STERLING Mailing Address SAME City JZip A QuiNTA X2252 Contractor OWNER BUILDER Address . t+GGf�GV. P.O. BOX 1504. N o . 1084.0 78-105 CALLE ESTADO LA QUINTA, CALIFORNIA 92253 BUILDING: TYPE CONST.. -----:--OCC'. GRP.- ' 1, A:P. Number Tel. 564-3236 Legal Description Project Description SEWER HOOKUP BY: Minimum Setback City Zip Tel.: Rear Setback from Rear Prop. Line t Building Address 53-920 .VILLA Owner HAROLD,' STERLING Mailing Address SAME City JZip A QuiNTA X2252 Contractor OWNER BUILDER Address . t+GGf�GV. P.O. BOX 1504. N o . 1084.0 78-105 CALLE ESTADO LA QUINTA, CALIFORNIA 92253 BUILDING: TYPE CONST.. -----:--OCC'. GRP.- ' 1, A:P. Number Tel. 564-3236 Legal Description Project Description SEWER HOOKUP 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. CONSTRUCTION LENDING AGENCY' I hereby affirm that there is a constiuction lending agency for the performance of the work for which this permit is issued.. (Sec. 3097, Civil Code.) , Lender's Name Lender's 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. 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 ZONE: BY: Minimum Setback City Zip Tel.: Rear Setback from Rear Prop. Line State Lic. & Classif. City Lic. # Sq. Ft. Size - No. No. Dw. Stories Units - ' Arch., Engr., Designer. New ❑ Add ❑ Alter ❑ Repair ❑ -Demolition ❑ Address Tel. City Zip State Lic. # Validation: LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I 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 effect. - - SIGNATURE .DATE OWNER -BUILDER DECLARATION 1 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 permittoconstruct, alter, improve, demolish, or repaii any structure, prior to. its issuance also requires the .applicant for such permit to file a signed statemenrthat he .IS licensed pursuant to _ the • provisionsof the Contractor's Ucense'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 five hundred dollars ($500). - O 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. If, however, the building or improvement is sold within one year of completion, the owner -builder willhave the burden of proving that he did not build or Improvefor the purpose of sale.) ' ❑ I, as* owner of the property, am exclusivelycontracting -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 �-r such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) ❑:I am exempt under Sec. •B. & P.C. for this reason Estimated Valuation G 5 1 A 00 PERMIT - - AMOUNT ` Plan Chk. Dep. .. Plan Chk. Bal.. Const. ' _ Mech.. Electrical •- Plumbing $-30. 00 S.M.I. ... Grading Driveway Enc. . Data 6 f' "''� Owner r r Infrastructure WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self -insure, ora 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...'?t ert 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.) 1 certify that in the performance of thg 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 . Owner r r h A _,,..ZZ.ir a ei r r e rtY{i 6 4 1C 3. tai TOTAL � 30. 04) REMARKS. 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. CONSTRUCTION LENDING AGENCY' I hereby affirm that there is a constiuction lending agency for the performance of the work for which this permit is issued.. (Sec. 3097, Civil Code.) , Lender's Name Lender's 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. 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 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- ate Permit'Validated Validatedby: Validation: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES r NO. PLUMBING FEES IST FL. SQ. FT. ® $ 2ND FL. SQ. FT. POR. SQ. FT. ® GAR. SO. FT. ® CAR P. SQ. FT. @ WALL SQ. FT. ® SO. 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 FLOOR DRAIN MECHANICAL FEES HEATING (ROUGH) WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASH ER(AUTO)(DISH) APPLIANCE DRYER DUCT WORK GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR, SUSPENDED LAUNDRY TRAY AIR HANDLING UNIT CFM HEATING (FINAL) 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. SQ. FT. ® c BATH TUB BOND BEAM SO. FT. @ c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SQ. FT. RESID ® 1% c SEWAGE DISPOSAL LUMBER GR. SQ.FT.GAR ® 3Y.c HOUSE SEWER FRAMING FINAL INSP. 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 GH 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 INSPECTIONS CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL COACHELLA VALLEY WATER DISTRICT f ai®0 CASH RECEIPT DETAIL Received From:. Date:, i Address: ''� � - ! "" ' � iv" : Account No. (';,. !;� = �� _fir_ -- �Lot(s), 'j V F t ' 1 Tract''- � - `" _ L r Service Address _.__. G.A_Code ' - ❑ Meter(s) . $ ❑ Service(s) t ❑ Backflow(s) ❑ 'House Lateral(s) ❑ DetectorCheck(s) - ❑ Meter Surcharge J _ -H'-SanitationCapacity Charge ❑ W.S.B.F.C. ❑ Temporary Construction Meter 's ❑ Turn on Charge ❑ Uncollected Account - Name _ ❑ Inspection Fee = Tract - ' • Fee- 0 Plan Check fees Water I Sewer - Tract -. ❑ Bond Payment - A. D. - Bond Assmt. ❑ Customer Deposit ❑ Other ' TOTAL Remarks: ❑Copy to: Cash �— ; ; 1 r Water Service Check r Mone Y l I�- Cashier Order - CVWD-438(11/89) ' ,. .1�� . • .tet • . . R