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15736 (PLBG).......... _ Building 52-435 Eisenhower Or. Address Owner 1 Blunt Mailing Address Same City Zip Tel. Its Quanta, C 92253 Contractor Eaono ewer Service Address P.O. Box 192 P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 -Valm. Desert, 4M 92252 1-346-2793 State Lic. I City & Classif. C-42 4$996a Lic. # Arch., Engr., Designer Address Tel. City (Zip ( State Lic. # e__ LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Divi a"�,io+n' 3.of-the usiness and Professions Code, and m license is in ful .force and effect. �. k ; .+ y - btr %1 — QWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason: (Sec. 7031-5,11usinest 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 more than Ove 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, 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.) O 1, 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) pcensed pursuant to the Contractor's License Law.) ❑ 1 am exempt under Sec. B. & P.C. for this reason Date Owner WORKERS' COMPENSATION DECLARATION Zt I hereby affirm that I have a'certificatq of consent to self -insure, or a certificate of Worker's Compensation Insurance, or 41,cert fieri copy thereof. (Sec. 3800, Labor Code.) Policy o. Company BVCopy,, is filed with the city. O Ceti ` opy is hereby furnished. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed If the, permit is for one hundred dollars (S100) valuation or less.) I certify that in the performance of the 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. Dt No. 15736 LDING: TYPE CONST. OCC. GRP.-. .P. Number egal Description roject Description Sewer Connect Sq. Ft. No. No. Dw. Size - Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ r Estimated Valuation $903.00 PERMIT AMOUNT Plan Chk. Dep. ` Plan Chk. Bal. comply with such provisions or this permit shall be deemed revoked. Const. Mech. Electrical Plumbing 30.00 S.M.I. Grading SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES -UP TO ONE Driveway Enc. Infrastructure Side Setback from Property Line DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ' ATTORNEY'S FEES. FINAL DATE INSPECTOR This is a building permit when properly filled out, signed and validated, -and is subject to TOTAL 30. 00 REMARKS .� ! ` •. I certify that I have read this application and state that the above information,is correct. Issued by: R t �• UVY 9 A , 1 agree to comply with all city and county ordinances and state laws relating to building �J Y 1 r NOTICE TO APPLICANT If, after making this Certificate of Exemption you • should become ZONE: BY:� subject to the Workers' Compensation provisions of the labor Code, you must forthwith Minimum Setback Distances: comply with such provisions or this permit shall be deemed revoked. Front Setback from Center Line Rear Setback from Rear Prop. Line WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE -IS UNLAWFUL, AND Side Street Setback from Center Line SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES -UP TO ONE HUNDRED THOUSAND DOLLARS ($100,00)), IN ADDITION TO THE COST OF COMPENSATION, Side Setback from Property Line DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ' ATTORNEY'S FEES. FINAL DATE INSPECTOR 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. Issued by: Date Permit 1 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. Validated by: Signature of applicant Date Mailing Address . Validation:' City, State, Zip CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBINU FEES IST FL. SO. FT. ® $ UNITS SLAB GRADE ROUGH PLUMB. BONDING YARD SPKLR SYSTEM 2ND FL. SO. FT. p FORMS �A SEWER R 7 ROUGH WIRING MOBILEHOME SVC. BAR SINK POR. SO. FT. ® GAS (ROUGH) METER LOOP GAR. SO. FT. ® POWER OUTLET ROOF DRAINS ; GAS (FINAL) TEMP. POLE DRAINAGE PIPING CAR P. SO. FT. GROUT WATER HEATER WALL SO. Ff. FINAL INSP. DRINKING FOUNTAIN SO. FT. ® WATER SYSTEM URINAL ESTIMATED CONSTRUCTION VALUATION $ _$ WATER PIPING NOTE: Not to be used as property tax valuation FRAMING 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 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'A c SEWAGE DISPOSAL INSULATION/SOUND SO.FT.GAR ® 3/ac HOUSE SEWER FINISH GRADING GAS PIPING PERMIT FEE FINAL INSPECTION ERMIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEE MECH.FEE PPL.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 �A SEWER R 7 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. wo _ FINAL INSP. FRAMING FINAL INSP./� DC v 1J ROOFING REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATION/SOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIONATURESIINITIALS GARDEN WALL FINAL I COACHELLA VALLEY NATER DISTRICT CASH RECEIPT DETAIL Received From: '` IV,r' It Address: f'C%i •��ar'f `inti Ir.3'1"l �':C ilrst� Account No. - / L(s) l Y Service Address._.�� — > < eclJ� h 4n 3! . 1-P �✓ ❑ Meter(s) ❑ Service(s) ❑ Backflow(s) ❑ House Laterals) ❑ DetectorCheck(s) ❑eSurcharge r ZtionCapacity Charge 9 �� ❑ W.S.B.F.C. ❑ Temporary Construction Meter ❑ Tum on Charge ❑ Uncollected Account - Name ❑ Inspection Fee - Tract - Fee - ❑ Plan Check Fees Water I Sewer - Tract - ❑ Bond Payment - A.D. - Bond ❑ Customer ❑ OVier_ Remarks: G.A. Code S TOTAL $ i K 64n331 ❑COPY to: CeSh Water Service cneclY 6 50 �� r Q/ Mone Cashier Order CVWD-438(11189) ECONO SEWER SERVICES AM MM MEM P.O. Box 192 46152 PALM DESERT, CALIFORNIA 92261 PHONE 328.7760 346-2793 " 9 USTOMER'S ORDER NO. PHON MECH IC HELPER STARTING DATE BILL TO ORDER TAKEN BY ADDRESS J - Imo- DAY WORK CONTRACT ❑ EXTRA I 14 JOB NAME AND LOCATION JOB PHONE ION OF PAYMENT TERMS NELO DAYS FROM DATE OF SERVICE 1%% PER MONTH CHARGE AFTER 30 DAYS Signature PRDDIU 258-2Ees Inc GmIcIn Man 01471. E] No one home ❑ Total amount'Sue for above work: or • I hereby acknowledge the satisfactory completion of the above described work Total billing to be mailed after completion of work TOTAL MATERIALS TOTALLABOR PLEASE PAY FROM THIS !NVeoeE NO STATEMENT WILL BE MAILED TAX DATE COMPLETED WORK ORDERED BY TOTALAMOUN Signature PRDDIU 258-2Ees Inc GmIcIn Man 01471. E] No one home ❑ Total amount'Sue for above work: or • I hereby acknowledge the satisfactory completion of the above described work Total billing to be mailed after completion of work