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10089 (PLBG)Building Address 53-820 Herrera P.O. BOX 1504 _ 78-105 CALLE ESTADO LA QUINTA, CALIFORNIA 92253 Udk Karen Blain Mailing Address >:Sam,W City Zip92253 Tel. LaQuinta Contractor FVs Pi in %nick Stevenson ...Address. 44757 Saxe Jinn' City 'Zip Tel.: Pelma Desert 92260 341-6546 State Lic. City & Classif. C36 602396 Lic. # 1914 Arch., Engr., Designer Address Tel. City Zip State Lic. # LICENSED CONTRACT_OWS DECLARATION Isfiereby aftirim't_li T licet�spndei plovisioft of C4py Qmmencingwith Section 000) of Dlvi onr ofBu ihese'and Pr7ilsslo s!C didense is in full force and ffect. S NATUR DATE 0%4 ER•BUILD DECLARATION I hereby affirm that I am a mpt 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, alter, 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, 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 or not more than five hundred dollars.(8500). ❑ 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, 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.) ❑ 1 am exempt under Sec. B. 8 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. 3900, Labor Code.) Policy No. Company ' ❑ 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.) I certify that in the performance^ort work for w ich this ermit is issued, I shall not employ any person in any manner so as to becom_ e P ct to he Worker �C pen ation Laws of California. +i Y '/f ♦ _s �r subject to the Workers(,�ordpensa0on ffirovigIols of the—Ta6or Code, you must forthwith comply with such provisions or this permit shall be de ed 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 No. 10089 BUILDING: TYPE CONST. OCC: GRP. A.P. Number ,Legal Description Project Description Sewer Hock Cep t Sq. Ft. No. No. Dw. Size Stories - Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ PERMIT AMOUNT Plan Chk. Dep. Distances: Plan Chk. Bal. Front Setback from Center Line Const. Rear Setback from Rear Prop. Line Mech.. Side Street Setback from Center. Line Electrical Side Setback from Property Line Plumbing FINAL DATE S.M.I. Issued by: Grading „4i`�.,t� A i;��,G9-c-+s,r, f•:!S 3.' Driveway Enc. Infrastructure r s TOTAL A.1TJ U a'W m REMARKS 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: I CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SQ. FT. ® $ UNITS SLAB GRADE ROUGH PLUMB. BONDING YARD SPKLR SYSTEM 2ND FL. SQ. FT. FORMS SEWER OR SEPTIC TANK ROUGH WIRING MOBILEHOME SVC. BAR SINK POR. SQ. FT. ® GAS (ROUGH) METER LOOP GAR. SO. FT. ® POWER OUTLET ROOF DRAINS GAS (FINAL) TEMP. POLE DRAINAGE PIPING CAR P. SQ. FT. GROUT WATER HEATER WALL SQ. FT. FINAL INSP. DRINKING FOUNTAIN. SQ FT @ WATER SYSTEM URINAL ESTIMATED CONSTRUCTION VALUATION $ _$ WATER PIPING NOTE: Not to be used as property tax valuation FINAL INSP. FLOOR DRAIN MECHANICAL FEES 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. SQ. FT. ® c BATH TUB SQ. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SQ. FT. RESID ® 1+/a c SEWAGE DISPOSAL SQ.FT.GAR ® V4c 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 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 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. FRAMING FINAL INSP. ROOFINGA _ /lj,w REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATION/SOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL COACHELLA VALLEY WATT-CIDISTRICT CASH RECEIPT DETAIL' 14 1 Received From: Z a f Address: - Account No'0 t (—a) Service Address • Meter(s) • Service(s) • Backflow(s) • House Lateral(s) • Detector Check(s) • Meter Surcharge Capacity Charge .,P<SanItatJon • W.S.B.F.C. • Temporary Construction Meter • Turn on Charge El Uncollected Account - Name • Inspection Fee - Tract - Fee - • Plan Check Fees Water I Sewer - Tract - • Bond Payment - A.D. --Boncl� Assmt. • Customer Deposit • Other Cl Copy to: Tract G.A. Code TOTAL