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10512 (PLBG)P.O. BOX 1504 N o . 1 512 78.105 CALLE ESTADO Address 53--385 Eise :haver LA QUINTA, CALIFORNIA 92253 Mer -ox Corporation Mailing BUILDING: TYPE CONST. OCC: GRP. Address A.P. Number City Zip Tel. #,a Qui>nsta Legal Description Project Description Contractor Lcono Sewer Hook Up Address P. 0. Box 192 City Zip Tel.: P.D. 1 92263 346--2797 State Lic. City & Classif. 48096.2 Lic. # 342 Sq. Ft. No. No. Dw. Size Stories Units Arch., Engr., Designer New ❑ Add ❑ Alter ❑ Repair ❑ 'Demolition'❑ Address Tel. City Zip State Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provi`slons of Chapter 9 (commencing with Section 7000) off Division 3 of the Business and Profe`sslons Code, and my license is in full) fforce and 4ftect 1 E` .. f _//. "E'er` - .. SIGNATUREr 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, 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 r7000) of Division 3 or 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 rive 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 or completion, the owner -builder will have the burden Of proving that he did not build or Improve for the purpose or sale.) -' Estimated Valu tionn PERMIT AMOUNT Plan Chk. Dep. Plan Chk• Bal. COf1St. — . Mech. •� Electrical � . (� (' Plumbing 30.00. 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) licensed pursuant to the Contractor's License Law.) ❑ 1 am exempt under Sec. B. & P.C. for this reason . S.M.I. - - Grading Driveway Enc. Date Owner Infrastructure 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.certifled_copy thereof. (Sec..3800,.Labor Code.) - Policy No. om opy Is filed with the city.❑ Certified copy Is hereby furnished. l`S13 `r!.{ A 41 8 ,) ^16-9` TOTAL `V 3tJ:' f�' A 1 a1r' a . V. V11 CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE REMARKS (This section need not be completed If the permit is for one hundred dollars ($100) valuation or less.) I 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: 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. ZONE: ' BY: Minimum Setback Distances: Front Setback from Center Line Rear Setback from Rear Prop. Line CONSTRUCTION LENDING AGENCY Side Street Setback from Center Line Ihereby affirm that there is a construction lending agency for the performance of the work for which this permit is Issued. (Sec. 3097, Civil Code.) Side Setback from Property Line Lender's Name FINAL DATE INSPECTOR Issued by: Date Permit y Validated by: 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 Js correct. I agree to comply with'ail 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 Malling Address Validation: City, State, Zip CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBINGFEES 1ST FL. SQ. FT. ® $ UNITS SLAB GRADE 2ND FL. SQ. FT. BONDING YARD SPKLR SYSTEM POR. 50. FT. ® MOBILEHOME SVC. BAR SINK GAR. SQ. FT. ® POWER OUTLET ROOF DRAINS FOUND. REINF. GAS (ROUGH) DRAINAGE PIPING CAR P. I SO. FT. ® I REINF. STEEL WALL 5Q. FT. TEMP. POLE DRINKING FOUNTAIN. SQ. FT. ® GROUT URINAL ESTIMATED CONSTRUCTION VALUATION $ FINAL INSP. WATER PIPING NOTE: Not to be used as property tax valuation WATER SYSTEM FLOOR DRAIN MECHANICAL FEES =$ WATER SOFTENER VENT SYSTEM FAN EVAP.000L 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 SPARK ARRESTOR SQ. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 1% c SEWAGE DISPOSAL LATHING SQ.FT.GAR ® Vhc 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 SEWE l OUGH WIRING. DUCTWORK ROCKSTORAGE 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 INSULATION/SOUND FINISH GRADING FINAL INSPECTION/ 'Rl j Z c CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL a COACHELLA VALLEY WATER DISTRICT CASH RECEIPT DETAIL Received From: ) r T-i<_� /--(-.C7[[ r.f•t J--/1 LA 1 Address: 4,). '1 `-'y%C'� Y? � (_U-Zn_ .4 4,,l & L Account No. � -, Lot(s) Service Addresses ' �� (.`'.-// /-�C_%l:<.•'' /i ��L ❑ Meter(s) ❑ Service(s) ❑ Backllow(s)-_ ❑ HouseLate ra.l(s) ❑ DetectorCheal.(s) ❑ M at er Surc hai g P,.S9-nitationCapacity Charge D/ J r ❑ W.S.B.F.C. '-- _ ❑ Temporary Construction Meter ❑ Tum on Char_tr, __ ❑ Uncollected Account - Name - 0 Inspection I' oe - I Tact - Fee - ❑ Plan Check rep:; Water ! Sewer - Tract - ❑ Bond Payment A.D. --Bond Assmt. ' ❑ Customer Deposit. ❑ Other a ""35,963, TOTAL $ 1 -7D- T1 D_ Remarks: ` `(%i'f.,y�, t.t1j t t' ❑copy to: Cash _ - Water Service Check Money ! Cashly Order ; VVVW- 38(11189)