15259 (PLBG)Building
Address 51-573 Xvenida
P.O. BOX 1504
78-495 CALLE TAMPICO
LA OUINTA, CALIFORNIA 92253
No. 15259
.oma :scz� i n. s .a.zvamAac:.i
Mailing
Address 2240 Yuma Way
BUILDING: TYPE -CONST. OCC: GRP. -
A.P. Number
Legal Description
Project Description sewer cot nection
i
City `�
Fullerdoxt!
Zip
92365
Tel.
Contractor.
Date land Construction Co. Inc.
Address
50395 Riga`^a113
City
Coachella
Zi
2235
Tel.:
398-5544
State Lic.
& Classif. 396698
City
Lic. # 31
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 herebbaffirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division f the'Businessand Professions Code, and my license is in full force al
eftec,� tJr% ° l d�tr rA7'�.�fd'j 4A}3 tICBiG➢J�Y C.D, % � "
s.e
SIGNATURE DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractors License Law for the following
reason: (Sec. 7031.5,Buslness 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 Isexempttherefrom, and the basis
for the alleged exemption. Any violation of Section 7031.5 by 'any applicant for a permit
subjects
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. 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.)
❑ 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.) ,
O 1 am exempt under Sec. B. & P.C. for this reason
Estimated Valuation $20-000.00
'PERMIT
AMOUNT
Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
'
Electrical
-
Plumbing
30.00
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 certified copy thereof. (Sec. 3800, Labor Code.)
Poli.cyy� No. Company
eCopy Is filed with the city, ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS'COMPENSATIONINSURANCE
(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 the work for which this permit is issued, I shall not
employ any person 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.
TOTAL_
30.00
REMARKS
ZONE: -;-BY:
Minimum Setback Distance�1
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-
conslruction, and hereby authorize representatives :of this city to enter the above-.
mentioned property for inspection purposes.
Signature of applicant Date
Center Line
Sear Prop. Line
,from Center Line
'copertv Line
FINAL DATE% f
'Issued by: a Permit
Validated by:-' 1
Validation:
City, State, Zip
r ,
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBINU FEES
1ST FL. SO. FT. ® $
UNITS
SLAB GRADE I
�
BONDING
YARD SPKLR SYSTEM
2ND FL. SO. FT.
FORMSSEWER
S T
ti
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
GAS (ROUGH)
METER LOOP
�
POWER OUTLET
ROOF DRAINS
GAR. S0. FT.
TEMP. POLE
GROUT
DRAINAGE PIPING
CAR P. SO. FT. ®
FINAL INSP.
WALL � S0. FT.
ER SYS
DRINKING FOUNTAIN,
GRADING
CU. yd.
$ plus x$
-$
URINAL
SO. FT.
FRAMING 1 '
FINAL I
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation %
REMARKS:
FLOOR DRAIN
1 MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALLI FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT ] CFM
SPARK ARRESTOR ,
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 ® 11/4 c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ac
HOUSE SEWER
GAS PIPING
PERMIT FEE }
PERMIT FEE
PERMIT FEE
DBL
TOTA1L FEES
1
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK 1
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE I
ROUGH PLUMB.-
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMSSEWER
S T
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF. I
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL '
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
ER SYS
GRADING
CU. yd.
$ plus x$
-$
LUMBER GR.
FI L INSP.
FRAMING 1 '
FINAL I
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING ' I
FIREPLACE
SPARK ARRESTOR ,
GAR. FIREWALL
LATHING
MESH +
INSULATION/SOUND I ,
FINISH GRADING
FINAL INSPECTION
CERT. OCC. 1
FENCE FINAL I +
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL
COACHELLA VALLEY WATER DISTRICT
CASH RECEIPT DETAIL
Received From C i. l C (�� 7 11,(� /z/U7_ ii C,
Address: L -
count No.
Service Address+
❑: Meter(s)
u Servlce(s)
S to
ot(s)
Backflow(s)
House Lateral(s)
DetectorCheck(s)
Ci Meter Surcharge
J;i,, anitatlonCapacityCharge
C. W.S.B.F.C.
EJ Temporary Construction Meter
Turn on Charge
L-1 Uncollected Account - Name
0 Inspection Fee - Tract -
Fee -
Plan Check Fees Water / Sewer -
Tract -
(� Bond Payment - A.D. - Bond
Assmt.
G Customer Deposit
G OtJ1er
Remarks:
U00,Y"to:
Cash Water Service
_Check
Money : Cashier.
VWD-438 (11/ 89)