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15293 (PLBG)_.; Buildingat Owner 54-370 ftse l::J;aler Dr. Coachella Valley :rind P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Add;ess 78-150 Calle Tampico #230 City Zip T75 La gul.nt4, CA 9225364.5522 Contractor ovmer/Builder Address Zip State Lic.I City & Classif. Lic. # -Arch., Engr., Designer Address Tel. City Zip State Lic. # 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. T16NATURE DATE OWNEWBUILDER DECLARATION I hereby affirm that I am exempt from the Contractors License Law for the following reason: (Sec. 7031.5,austness 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 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 five hundred dollars ($500). 044 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 snprove for the purpose of sale.) ❑ 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 wfro^ ildsror improves thii�dGeon, and who contracts for such projects with a contractor(s) #tensed urs t to the C tracto/r,'e License Law.) ❑ 1 am exempt under Sec. & P F or this riaIf Date f ^ wner i P WORKERS' COMPENSATION DECLARATION I hereby affirm that 1 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 N -"- .Company py is filed with the city. O Certified copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not'be completed B the permit is for one hundred dollars (SI00) valuation or less.) I certify that in the performance of thq work for which this permit is issued, I shall not employ any PPerson in any manner so as to become subject to the Workers' Compensation Laws of Callfornia. Date Owner NOTICE TO APPLICANT., d, alter 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. WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND' SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED, THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. 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 ,i No. 15293 BUILDING: TYPE CONST. OCC: GRP. A.P. Number ,Legal Description Project Description Sewer Connect 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. 12(3 S.M.I. Grading Driveway Enc. Infrastructure TOTAL -3 •00 REMARKS ZONE: BY: Minimum Setback Distances: - Front Setback from Center Line Rear Setback from Rear Prop. Line Side Street Setback.from Genter'Line Side Setback fronnQ LLine FINAL DATE �/ INS�GTOR-1- J Issued by;— Date r Permit Validated by:%(a Validation: V o CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBIWQ FEES IST FL. SO. FT. ® $ UNITS COLL. AREA SLAB GRADE YARD SPKLR SYSTEM 1 2ND FL. SO. FT. @ BONDING HEATING (ROUGH) MOBILEHOME SVC. BAR SINK POR. SO. FT. ® JN ROUGH WIRING GAR. SO. FT. ® POWER OUTLET ROOF DRAINS FOUND. REINF. GAS (ROUGH) DRAINAGE PIPING CAR P. I SO. FT. ® HEATING (FINAL) WALL S0. FT. REINF. STEEL DRINKING FOUNTAIN SO. FT. ® TEMP. POLE URINAL ESTIMATED CONSTRUCTION VALUATION $ WATER PIPING NOTE: Not to be used as property tax valuation FLOOR DRAIN MECHANICAL FEES WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER GRADING cu. yd. $ -plus-x$ GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED LAUNDRY TRAY AIR HANDLING UNIT CFM FINAL INSP. ',��®J 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+/e c SEWAGE DISPOSAL LATHING SO.FT.GAR ® 3/ac HOUSE SEWER MESH 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 SEW 0 JN 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. ',��®J ROOFING /J REMARKS: VENTILATION FIRE ZONE ROOFING�(f FIREPLACE r SPARK ARRESTOR GAR. FIREWALL C LATHING MESH INSULATION/SOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL COACHELLA VALLEY WATER DISTRICT �.,R 65$ �.p CASH RECEIPT DETAIL He- i 7 J Received From: COA , L C. ( a N Address: 7/��J- /rr Lot(s) Service Address -:SU— 37A Y -S / 1 C lL 1= E& ❑ Meter(s) ❑ Service(s) - ❑ Backflow(s) r ❑ House Lateral(s) ❑ DetectorCheck(s) ❑ Meter Surcharge anitatlon Capacity Charge Q ❑ 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 Deposit ❑ Other Remarks: 1-7 U Date: %-12-7 4 . Tract— S G.A. Code S 1 2S. TOTAL S /7ZSr i;wp-y to: -` Cash _ � Water Service Check Z.XJ Money Cashler Order' CVWD-138(11189) . COACHEI 0A. Received From* - Address: r, A t t&t : t r,-2-",: • Account No. ,- .5,5 Service Addfessirl Arl 0 Meter(s), 0 Service 0 8ackflow(s 0 House Laterals) Detector heck(s)PX�4"- 0 C 4N F . 0 MeterSurchaq 4�4 'a Mw<n-1ttI-1%1114) kc -1 SAW, A 0 W.S.B.F.C. AN 0 Temporary Co-nsiructlon Meter=AX 'qr&-&AMx94* .4 VW 'm 7-0r—r,- O'Turn an Charge "C3 Ptncollec'ted Acmuint - Nanis!!� -.0 Inspection Fee -Tract Fee ;L: 0 Plan Check Fees Water f Sews ov Alt", .Tract- Cl 'Bond Payment A.D. Bond Ais t 0 Customer Deposit 0 Other ;V Remarks: oCopy to: Cash Check Money Order VALLEY WATER DISTRICT I RECEIPT DETAIL 2- --, Nxg Tract r G.A. Code �m TOTAL Water Service Cashier_ (11189)