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10521 (PLBG)P.O. BOX 1504 j , N o . 10521 Sas 53-835 HERRERA LA QUINOTA CALIFORNIA 92253 I r` MICHAEL HIGEIdBER7;! BUILDING: TYPE CONST. ` OCC. GRP. - Address 71-560 BISKRA RD City lZip ITel. u1Mk%%0nV MILULI %xil. Contractor JOE STEMMER Address 54-425 HERRERA City Zip . Tel.: LA QUILT® Alter ❑ Repair ❑ 564-4580 State Lic. City & Classlf. 605857 Lic. # 2119 Arch., Engr., Designer Address Tel. City IZIp Sta I Lic.t# $**9 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. SIO ATl1RE DATE OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractors License Law for the following reason:. (Seo. 7031.6,Buslness and Professions Code: Any city or county which requires e 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 8 (commencing with Section 7000) of Division 3 of the Business and Professions Code; or that. he la exempt therefrom, and the basis for the alleged exemption. Any violation of Section 703 1. 6 by :any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($600). ' ❑-I as owner of the property, or my employees with wages as.thelr sole compensation, will do jhe 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 the'• such Improvements are not Intended or offered for sale. If, however, the bulldtng 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.) �1'I, as owner of the property, am exclusively contracting with licensed contractors to con- I' the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law dd ee not apply to en owner of property -who builds or Improves thereon, and who contracts .for such pro/acts with a aonfractor(s) licensed pursuant to the Contractor's License Lew.) ❑ 1 am exempt under Seo. S. & P.C. for this reason Date ihr /'7P" & nor `fir f%. % /.1:•;/it ' ''=,t�i e v.e'�9/1 _.%'ML'Y/LAS WORKERS' COMPENSATION DECLARATION j 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. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This Section need not be completed If the permit Is for one hundred dollars ($100) valuation or lose.) I certify that In the performance of the work for which this permit Is Issued, I shall not employ any perean In any manner eo es to become subject to the Workers' Compensation Levee of California. Date Owner NOTICE TO APPLICANT. If, 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 Ihereby affirm that there la 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 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' Melling Address City, state, Zlp P. Number al Description_ Project Description SEWER HOOKUP 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:: Sq. Ft. Size No. No. Dw. Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation $$1.700 PERMIT AMOUNT .Plan .Chk. Dep. Plan Chk. Bal. Const. Mech. ' Electrical Plumbing $30.00 S.M.I. Grading Driveway Enc. Infrastructure TOTAL $30.00 .REMARKS t4 .� `1OTAL_f -,�y.uu . 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. SO. FT. ® $ UNITS COLL. AREA SLAB GRADE YARD SPKLR SYSTEM 2ND FL. SO. FT. HEATING (ROUGH) STORAGE TANK POR. S0. FT. ® MOBILEHOME SVC. BAR SINK GAR. SO. FT. ® POWER OUTLET ROOF DRAINS FOUND. REINF. DRAINAGE PIPING CAR P. I SO. FT. HEATING (FINAL) OTHER APP.IEOUIP. WALL SO. FT. DRINKING FOUNTAIN. SO FT ® 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 GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED FINAL INSP. LAUNDRY TRAY AIR HANDLING UNIT CFM 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. SO. FT. ® c BATH TUB FIREPLACE SO. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 1Ve c SEWAGE DISPOSAL SO.FT.GAR ® V4c HOUSE SEWER 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�9�TICY�AAlls,i` / ROUGH WIRING. DUCT WORK ROCK STORAGE FOUND. REINF. GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APP.IEOUIP. 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 I Iv.�niitF,&?J,i�*:�.:�J�-tr'�'!:':i'�'8'"�'{s,.;rAK�..+w-i7 'ii''. d"JrlNtc::o:W.:.: en'!.c..,^:°..t);w.i.yy;, $'=;i j c -., ^ �'`• � _ h-��1 �1'%.':J�S r`.r.-f'�':w':r ^r-'k�i',. .,r� :b ..e.. �. .. i,�i°:r�, .. �, .•til r4['w�'; off COACHELLA VALLEY WATER DISTRICT ,a� 1��+ CASH RECEIPT DETAIL f E Received From: i C f °:"f 4 k ��"'! #-.(( j1 Date: ` `-o Address: t ^' (o �� 1�C. �d G� LL nr— N_U �%1 L �"�`1 'Q Account No. � ��- Lot(s) Cn Tract C J C Service Address = �� t e Y i'� '� - G.A. Code ❑ Meter(s) $ ❑ Service(s) ❑ Backflow(s) ❑ House Lateral(s) ❑ DetectorCheck(s) ❑ Meter Surcharge Q-1 anitation 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 TOTAL $ _7 Remarks: ❑Copy to: !Cash Water Service xheck oney;. �" 7 Cashierrder Cv1 ,D -a3 (11 /89)