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9633 (PLBG)TA hf 4 oul P.O. BOX 1504 No. 9633 Building 78-105 CALLE ESTADO Address 51-111 Desert Club Dr. LA QUINTA, CALIFORNIA 92253 / J Owner Eddy Nicholson BUILDING: TYPE CONST. OCC: GRP. Mailing Address A.P. Number City Zip Tel Legal Description Contractor Project Description Dateland Construction Co. Fibandla:a seDti.c and soak u>3 sewer Address . 50-•305 Hwy 111 City Zip Tel.: Coachella 92236 398-55 State Lic. City & Classif. 312854 C12, 34, 42 Lic. # 31 Designer Address Zip (State Lic. # LICENSED CONTRACTOR'S DECLARATION i)that I am li ensgd`under provisions of Chapter 0 (commencin n 3;of the Bu mess and Prdfessions Code, and,mylicense�is it OWNER -BUILDER DECLARATION I hereby affirm that 1 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. Dy 'any applicant for apermit subjects the applicant to a civil penalty of not more than five hundred dollars.($500). ❑ I, 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, Bulsness 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 contractors) licensed pursuant to the Contractor's License -Law.) ❑ 1 am exempt under Sec. B. & P.C. for this reason Date. Owner 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. . 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 ($100) valuation or less.) 1 certify that in the performance of thg work for which this'permit is issued, I shall not employ any parson 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. 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 it work thereunder is suspended for 180 days. I certify that I have read this application and stale 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 Sq. Ft. No. No. Dw. Size Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. Const. Mech. Electrical Plumbing 30.00 S.M.I. Grading Driveway Enc. Infrastructure TOTAL 30..00 f REMARKS /ire r�(g'{n rKri A. {bRa.' }Ar^' /.r. 1'rI 1 0 V 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. $0. FT. ® $ UNITS SLAB GRADE ROUGH PLUMB. BONDING YARD SPKLR SYSTEM 2ND FL. $0. FT. ® FORMS SEWER OR SEPTIC TANK POR SO FT ® MOBILEHOMESVC. BAR SINK GAR. SO. FT. ® POWER OUTLET ROOF DRAINS HEATING (FINAL) OTHER APPJEOUIP. DRAINAGE PIPING CARP. SO. FT. ® TEMP. POLE WALL S0. FT. GROUT DRINKING FOUNTAIN. SO FT ® FINAL INSP. URINAL ESTIMATED CONSTRUCTION VALUATION $ WATER SYSTEM WATER PIPING NOTE: Not to be used as property tax valuation =$ FLOOR DRAIN MECHANICAL FEES FRAMING WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER REMARKS: GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED LAUNDRY TRAY 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 ® 1 V c SEWAGE DISPOSAL MESH SO.FT.GAR ® 3/ic HOUSE SEWER INSULATIONISOUND 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 SEPTIC TANK ROUGH 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. II 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 J Received From: Address: &4x;7Account No. Lot(s) 4 -r lir Service Addre 0 Meter(s) • Service(s) • Backtlow(s) • HouseLateral(s) • Detector Check(s) • Meter Surcharge Sanitation Capacity Char El W.S.B.F.C. 0 Temporary Construction Meter 0 Turn on Charge 0 Uncollected Account - Name [D Inspection Fee - Tract - Fee - • Plan Check Fees water / sewer - Tract - • Bond Payment - A.D. -_Bond Assmt. 0 Customer Deposit O'Other Remarks: 0 copy to: 7Cash Check Ix I, Money Order r er ss G.A. Code )ate: -.2 TOTAL $ Water Service h Cashier_ � .�, CVWD-438 (11189)