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11046 (PLBG)'� r 17 Building Address 52-273 VILLA Owner GERALDE LESLIE 'llETZLEY Mailing Address SANE City Zip1564-3275 el. LA QUINTA 922.53. Contractor Address P.O. BOX 1504 78-105 CALLE ESTADO LA QUINTA,'CALIFORNIA 92253 11046. LDING: TYPE CONST. OCC: GRP. Number al Description ject Description SEWER HOOKUP NOTICE TO •APPLICANT. If, after inking this Certific-ate 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 construction 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: 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. 1 City Zip State . Lic.'#' . 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 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, after, improve, demolish, or repair any structure, prior to its issuance also. requires the applicant for such permit to file 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 nrore Nan five hundred dollars.($500).. as owner of the property, or my employees with wages as their soler compensation,.win. 2APlan he 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 will have the burden of proving that he did not build or Improve for the purpose of sale.) _ •- • - ❑ I, 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: 8: 8 P.C. for this reason r 1 EStlmated ,VdIUatlOn �^ - PERMIT - - AMOUNT ' - Plan Chk, Dep. ' _ Chk. Bal. r Const. ' Meeh. •' - Electrical Plumbing . $ 3 0.00 S.M.I. Grading. Driveway Enc. _ Date � V dd�-owner 1 I'a, ><,C l % .� Infrastructure WORKERS' COMPENSATION DECLARATION ! ' I hereby affirm that I have a certificate of consent to self -insure, or 'a certif tate of .Worker's Compensation Insurance, or a certified.copy thereof. (Sec. 3800,. Labor Code.) Policy No. Company O Copy is filed with the city. O 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 thispermit is issued, I shall not employ any person in any manner'so as to become subject to the Workers' Compensation Laws of Californian. �'sf\ { \•,t;' ( ,✓ `ate t. "f�Owner r l: 3 ii f 1 y r f e • C /'r nd qF; .sem•) a s -. t i�u'r' F -f "e e'J r '3o a �"� z � TOTAL s 30 .00 REMARKS ' NOTICE TO •APPLICANT. If, after inking this Certific-ate 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 construction 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' Validated by: Validation: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. -PLUMBING FEES 1ST FL. SQ. FT. ® $ 2ND FL. SQ. FT. POR. SQ. FT. ® GAR. SO. FT. ® CAR P. SQ. FT. WALL SQ. FT. ® SQ. 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 BONDING FLOOR DRAIN MECHANICAL FEES FORMS WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER GAS (ROUGH) GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED OTHER APPJEOUIP. LAUNDRY TRAY AIR HANDLING UNIT CFM TEMP. POLE 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 SQ. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SQ. FT. RESID ® 11/4 c SEWAGE DISPOSAL SO.FT.GAR ® 3/ac HOUSE SEWER REMARKS: 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 OR 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 r " CASH RECEIPT DETAIL �` Received Frroom_:. -�% Date: � ^� � � r i Address: d Account No. Q C Lots) Tract (742 Z % Service Address ���� G.A. Code ❑ Meter(s) $ ` ❑ Services) ° "'y.. ❑ Backflow(s) i " ❑ House Lateral(s) x ❑ Detector Check(s) ❑ Meter Surcharge Sanitation Capacity Charge l ❑ W.S.B.F.C. O Temporary Construction Meter 1 ❑ 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 E', TOTAL ^ $ ,mss S� Q fy 'Remarks: ❑Copy to: Cash Water Service Check Money Cashier Order CVWD-438 (11189)