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10015 (PLBG)P.O. BOX 1504 Building 78-105 53-925 DIAZ LA QUINTACCALIFORNIA 92253 Address . Owner DAVID MILLER Mailing Address 53-430 CARRANZA City Zip Tel. LA QUINTA 92253 Contractor NICK STEFgNSON/RFS PLUMBING Address 4475 SAN JUAN City Zip Tel.: PALM DESERT 92260 441-6546 State Lic. City & Classif. C36 602395 Lic. # 1914 Arch., Engr., Designer Address Tel. City (Zip( State Lic. # ' ' ' LICENSED CONTRACTOR'S DECLARATION I hereby affirm that 1 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. SIGNATURE - DATE OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from.the Contractor's License law for the following reason: (Sec. 7031.5,Suslness 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 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 buildsor: 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 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 contractors) licensed pursuant to the Contractor's License Law.) - O 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. ❑ Certified copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM P. WORKERS' COMPENSATION INSURANCE ( i (This section need not be completedif the rmft is for .one huned dollar_ (,$100) yaatlon or less.) f! { I certify that in the perfor nc of�th� rk for wh ch this permit is issued, I shall not empto6l anye arson in any rnann as t" b�comefubject-to th' Wo cers' Comp Ksatlon 1� li.Lawsof C811 brni J it DateC�w(rer� I AAA NOT( E T APPLICANT: Itr97terLnla !'g thlff CeJfillcate o/ Exemptio o s ould ecomi3- I subject to the Workers' 'Compensation provisions o the bor - e, you .must forthwith I comply with such provisions or this permit shall be deemed -revoked. CONSTRUCTION LENDING AGENCY.' 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.) Lender's Name 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 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. 10015 BUILDING: TYPE CONST. OCC: GRP. ,A.P. Number ,Legal Description Project Description SEWER HOOKUP Sq. Ft. Size No. No. Dw. Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ -Demolition ❑ 31 MAL i ZO 00 Estimated -Valuation $ 12.Q0 . PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. Const. $30.40 Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure TOTAL S U • JQ. REMARKS 4.. 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: Validation: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SO. FT. ® $ UNITS SLAB GRADE 2ND FL. SO. FT. BONDING YARD SPKLR SYSTEM STORAGE TANK MOBILEHOME SVC. BAR SINK POR. SO. FT. ® DUCT WORK ROCK STORAGE GAR. SO. FT. ® POWER OUTLET ROOF DRAINS HEATING (FINAL) OTHER APPJEOUIP. DRAINAGE PIPING CAR P. I SO. FT. TEMP. POLE WALL SO. FT. ® GROUT DRINKING FOUNTAIN SO FT ® FINAL INSP. URINAL ESTIMATED CONSTRUCTION VALUATION $ WATER SYSTEM WATER PIPING NOTE: Not to be used as property tax valuation =$ FLOOR DRAIN MECHANICAL FEES FINAL INSP. 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 VENTILATION KITCHEN SINK ABSORPTION SYSTEM B.T.U. TEMP USE PERMIT SVC WATER CLOSET' COMPRESSOR HP POLE, TEMIPERM LAVATORY HEATING SYSTEM FORCED GRAVITY AMPERES SERV ENT SHOWER BOILER B.T.U. SO. FT. ® c BATH TUB GAR. FIREWALL SO. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 1V• c SEWAGE DISPOSAL SO.FT.GAR @ 3/•c 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 SEWER OR SEPTIC TANK 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. ROOFING REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATIONISOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESJINITIALS GARDEN WALL FINAL Received From: /��2/�ww LJ/9 �i COACHELLA VALLEY WATER DISTRICT GASH RECEIPT DETAIL /�-" � :35f9ffi �"+w C l Date: �« I ! r ` Address: '4 3 f• �/� C. /� /2 R� G..a/N/ C /} Account No. Lot(s) 9 Tract SG BL iC t' qCi Service Address ✓�_� �- A !% ,! 9� Jl A 'L G.A. Code 7 �/—� clo ervice(s) r ! 2 ' ❑ Backflow(s) ❑ House Lateral(s) ❑ DetectorCheck(s) ❑ Meter Surcharge I nitation Capacity Charge �l h SS' , l 7"S ❑ W.S.B.F.C. ❑ Temporary Construction Meter ❑ Turn on Charge ❑ Uncollected Account -Name ❑ Inspection Fee- Tract - - Fee - ❑ Plan Check Fees Water / Sewer - Tract - ❑ Bond Payment - A.D. - Bond Assmt. ❑ Customer Deposit ❑ Other TOTAL i$ Remarks: ❑Copy to: Cash Check G') 5 Water Service Money Cashier Order , = CVWD-438 (11189) , Buena Engineers, Inc. u g 79-811 B Country Club Drive Bermuda Dunes, CA 92201 • (619) 345-1588 w 51 Client Name_ Client Address f t Client Phoneow . r�r'-wr'�-•. DATE . —7'23P ct JOB NO. st�-(Ql—o1 PROJECT f LOCATION FIELD TESTING CONTRACTOR REFERENCE CURVE OWNER WEATHERtom, 11C47 t! TEMP. oat AM 0 a PM PRESENT AT SITE OPTIMUM TEST TES iL'O;C'ATIO' �- LOT CLIENT REPRESENTATIVE SIGNATURE 9w FIELD REPORT TECHNICIANS SIGNATURE 13611 FIELD TESTING REFERENCE CURVE MOISTURE DRY MAXIMUM MAXIMUM OPTIMUM TEST TES iL'O;C'ATIO' �- LOT NUMBER /r' P` Np, ELEVATION CONTENT % DENSITY lbs./Cu. ft. DRY DENSITY DRY DENSITY MOISTURE CONTENT j 1 % lbs./cu.ft. % Ss 6 '1 0_j Co'7 11 / .. .k I � REMARKS: �:,, r A�} r ca Sl, Au 'I '^t c, O cC C. C�' L ( -'p S+ S G S r v. i t C G L.r �s•-�o . _`� ° CLIENT REPRESENTATIVE SIGNATURE 9w FIELD REPORT TECHNICIANS SIGNATURE 13611