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15004 (PLBG)Building Address . 52-620 Ave 4 P.O. BOX 1504 78-495 CALLE TAMPICO LA OUINTA, CALIFORNIA 92253 Mailing Address 52620 AVe Rubio City Zip T�"7564-7432 LaQuints 32253 Contractor Jr.W. Moffitt Construction . Address 83616 Avg 45 She 12 _ City Zip Tel.. Indio 922�i State Lic.' - City 8� Classif.. 3J{�361 • Lic. # Arch:, Engr., Designer J'✓Xry &10ffYtt Address Tel. No. 15004 BUILDING: TYPE CONST. OCC. GRP. A.P. Number Legal Description----= Project Description Sewei Hook. up 1AU 0 Sq. Ft. Size. New ❑' Addl ❑ No. Stories - - Alter ❑ No. Dw. .Units Repair`❑ Demolition ❑ 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 licenseis in full force and effect. - SIGNATURE DATE ' OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractors License Law for the.following Estimated Valuation -• . reason:.(Sec. 7031.5,Business and Professions Code: -Any city or county which requires a --- PERMIT .AMOUNT permit. to construct, after, improve, demolish, or repair any structure,. prior to its issuance also requires the applicant for,such permit to We 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 - - Plan Chk-. Dep- - - subjects the applicant to a civilpenafty of not more than five hundred dollars ($500). ❑ I, as owner of. the property, or my employees with wages as their sole compensation, will Plan Chk. Bal.; ' _ K Const.* V'ti3 ,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 Mech. — • •- " - ' 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 Electrical or Improvement is sold within one year of completion, the owner -builder will have the burden of proving that he did not buftd or improve for the purpose of sale.) Plumbing D1, 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 _ S. M.1. - -•! '� such projects with'a contractor(s) licensed pursuant to the Contractor's License Law.) ❑ I am exempt under Sec. B. 8 P.C. for this reason - 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 certified copy thereof. (Sec. 3800, Labor Code.) . - - Policy No. Company O Copy is filed with the city,, ❑ Certified copy is hereby furnished. - TOTAL 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 thework for which this Permit is issued I shall not employ any person in any manner so as tbecome'subject to te Workers' Compensation Laws of California. Date Owner 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. '' T =mac rom Center Line s--- Ile, etba f orn Rear Prop.. Line WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL, AND I - Side treet acK from Center Line SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP .TO ONE HUNDRED THOUSAND DOLLARS ($100,0,00), IN ADDITION TO THE COST OF:COMPENSAT.ION; Ide etba m Property Line DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND Ann 1 1�y ATTORNEY'S FEES. - APR 1 This is i building pem it when properly filled outi signed and validated, and is subject to FINA DATE NSPECTOR 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 ^ �t !'- Permit I agree to comply with all city and county ordinances and state laws relating to building . xxx construction, and hereby authorize representatives of this city to enter. the above. ��; mentloned property for inspection purposes. Validatt?d .by Signature of applicant Date' Mailing.Address Validation: City, State, Zip f f CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBINi: FEES,y, 1ST FL. SO. FT. ® $ 2ND FL. SQ. FT. p POR. SQ. FT. ® GAR. SO. FT. ® CARP. SO. FT. WALL SO. FT. ® -SO. FT. ® ESTIMATED CONSTRUCTION VALUATION $ UNITS MOBILEHOME SVC. POWER OUTLET - v YARD SPKLR SYSTEM BAR SINK ROOF DRAINS DRAINAGE PIPING DRINKING FOUNTAIN. URINAL WATER PIPING NOTE: Not to be used as property lax valuation ROUGH PLUMB:' FLOOR DRAIN MECHANICAL FEES HEATING (ROUGH) WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASH ER(AUTO)(DISH) APPLIANCE DRYER `DUCT WORK GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED GAS (ROUGH).. '.. 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 SQ. FT. ® c - WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 11/4 c SEWAGE DISPOSAL LUMBER GR. SO.FT.GAR ® 3/ac HOUSE SEWER FINAL INSP: 9 ROOFING 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 TANKS FORMS SEW O ROUGH WIRING `DUCT WORK : ROCK STORAGE FOUND. REINF. GAS (ROUGH).. '.. METER LOOP HEATING (FINAL) OTHER APP./EQUIP.' REINF. STEEL - GAS (FINAL) TEMP. POLE GROUT WATER' HEATER 1SERVICE FINAL INSP. BOND BEAM WATER'SYSTEM GRADING . tu. yd. $ plus z$ _$ LUMBER GR. / y/ FFINAL INSP. FRAMING FINAL INSP: 9 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 SIGNATURES11NITIALS GARDEN WALL FINAL ECONO SEWER SERVICES P.O. Box 192 PALM DESERT. CALIFORNIA 92261 r + ' 40M MOM 8MOQ 45436 PHONE 328-7760 346-2793 DA RD CUSTOMER'S ORDER NO. PHONE M NIC HELPER STARTING A E BILL TO ORDER TPKEN By ADDRESS.- ' DA" WORK El CO-4TRACT - EXTRA - cI y �' - ZAT61-A a - JOB NAME ANDJC ' JOB PHONE 'DAVMCIJT TERMS NET 1-0 DAYS FROM DATE OF SERVICE , `•1%96 PER MONTH CHARGE AFTER 30 DAYS a TOTAL MATERIALS ' TOTAL LABOR PLEASE PAY F NGE NO STATEMENT WILL BE MAILED TAX DATE COMPLETED - /I WORK ORDERED By ' TOTALAMOLTIT/ Y-5/ V/ter' ❑ No one home 0 Total amount dui Total billing to Signature for above work: or be mailed after completion GmWd r 01 Ees Inc I hereby acknowledge the satisfactory completion - of work Gmwn Mau oi4n. Of the above described work ECONO SEWER SERVICES �0 MOM OEM P:O. Box 192 45436 PALM DESERT, CALIFORNIA 92261 PHONE 328-7760 -346.2793 M NIC LPER STARTING DA E CUSTOMER'S ORDER NO. PHONE HE . ORDE /AKEN BILL TO • , ADDRESS - ' 0 DAYWORK , v C] CONTRACT cl Y C C] EXTRA . 'JOB NAME AND CATION JOB PHONE - EROM DUE OE SERVICE " DESCRIPTION O WORK: 1%% PER MONTH CHARGE AFTER 30 DAYS ' TOTAL MATERIALS - i TOTAL. LABOR NO STATEMENT WILL BE MAILED TAX DATE COMPLETED WORK ORDERED BY TOTAL AMOUNT" 11 -1-1 kul;n 1n