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PLBG (10879)- P.O. BOX 1504 I✓ No. 10879 Building 78-105 CALLE ESTADO Address 52-690 Navarro LA QUINTA, CALIFORNIA 92253 Owner Directors Mortgage BUILDING: TYPE CONST. OCC: GRP. Mailing Address 1595 Spruce St A.P. Number City Zip Tel. Riverside 92507 Legal Description Contractor Project Description RVS Plumbing/nick Stevenson Address "Sewer Hook Up P. 0. Box 692 Cit Rancho Mirag=; State Lic. p 92270 I el.: 341-6546 & Classif. C36 602396 Lic. # 1914 I Sq. Ft. II -Size Designer Address Tel. CityI Zip I State I Lic. # I hereby`affirm that,j.aih licensed under p ovisions o Chapter 9 (commencing with Section Mot Division +3�,.d�f therB.u)sinesa and Pr fessiogs C e, and my license full force and Ffecf./Z/ A Jai , 114 Zr,Z9 (2e, OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason: (Sec. 7031.5,Buslness 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 rile a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) or 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 penally of not more than Five 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. 1t', however, the building or Improvement is sold within one year of completion, the owner -builder will have the burden or 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. & 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. 3800, Labor Code.) Policy No. Company ❑ Copy is filed with the city. O Certified copy is hereby furnished. WORKERS' COMPENSATION INSURApd (This section need not be completed If the permit is for one hundred dollars ($100) valuation or less.) I certify that in the performance-owork for whichthis per,�nit is_ issued, I hall not employ any person in any manner _*o-A`sJtr�ecgrme subih tom erk rs' Compensation subject to the Workers Compen`satTon firovisions gy the LAOcode, - yoYi must forthwith comply with such provisions o��s:#ermit shall be deem 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 Lenders 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. No. Dw. Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ ILstlmatea valuation 1,000 PERMIT Plan Chk. Dep Plan Chk. Bal. Const. Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure TOTAL AMOUNT 30.00 REMARKS Ltr >#OYt 3 ii!iHL L IkrxVV 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: Validati CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SQ. FT. ® $ 2ND FL SQ. FT. POR. SQ. FT. ® GAR. SO. FT. ® CAR P. SQ. FT. WALL SQ. FT. @ SQ FT ® ESTIMATED CONSTRUCTION VALUATION $ UNITS MOBILEHOME SVC. POWER OUTLET YARD SPKLR SYSTEM BAR SINK ROOF DRAINS DRAINAGE PIPING DRINKING FOUNTAIN. URINAL WATER PIPING NOTE: Not to be used as property tax valuation FLOOR DRAIN MECHANICAL FEES HEATING (ROUGH) WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER DUCT WORK GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED LAUNDRY TRAY AIR HANDLING UNIT CFM HEATING (FINAL) 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 BOND BEAM SO. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SQ. FT. RESID ® 1 Vi c SEWAGE DISPOSAL LUMBER GR. SQ.FT.GAR ® Vic HOUSE SEWER, FINAL INSP. ROOFING GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEE MECH.FEE PLCK.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 O%`®� UGH 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. ROOFING REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATION/SOUND FINISH GRADING FINAL INSPECTION 1- 3o O)- CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESfiNrMLS GARDEN WALL FINAL COACHELLA VALLEY WATER DISTRICT CASH RECEIPT DETAIL Received From: -7 te: Address- Account No. Lot(s) 42 Service Address Tra &---4 0 Meter(s) G.A. Code 0 Service(s) $ 0 Backflow(s) D House Lateral(s) 0 Detector Check(s) 0 Meter Surcharge Sanitation Capacity Charge "+Erb 0 W.S.B.F.C. "'5' C) 0 Temporary Construction Meter 0 Turn on Charge 0 Uncollected Account - Name 0 Inspection Fee - Tract - --------- Fee - 11 Plan Check Fees Water I Sewer - ------ Tract - E3 Bond Payment - A.D. -- Bond _ - -------- Assmt. CI Customer Depopit Other Remarks: TOTAL $ 0 COPY to: Cash Check Water Service Money Order Cashier­ CVWD-438 (11/89)