15006 (PLBG)�j •4 4 "
P.O. BOX 1504
Bui.bing 53-700 Ave QbX'f' on 78-495 CALLE TAMPICO
Address q LA QUINTA, CALIFORNIA 92253
OwntT
No. 15006
earl Valentne
BUILDING: TYPE CONST. -
A.P. Number
Legal Description
Project Description gr_Tar _r Hein?
OCC. GRP.-
—un
Mailing
Address 53-700 Ave obregron
City
%a Q>< rota
Zip
922'53
Tel. + '
56.4-5923
Contractor
M.L. Construction
Address
P.O. Box 228
City
�a Qu
Zip
92253
Tel.:
564-444'
State Lic.
& Classif.344335-b-c36
City
Lic. # 2051
Sq. Ft. No.
Size. Stories
No. Dw.
Units
Arch., Engr.,
Designer
New ❑ Add ❑ Alter ❑
Repair.❑ Demolition ❑
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 an rProfessions Code, and my license is in full force and
effect.Division
J /f
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,Sustness and Professions Code: Any city or county which requires a
permit to construct, after. Improve, demoltsh, 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) 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 rive hundred dollars ($500).
0.1, 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.)
O I, as owner of the property, am exclusively contracting with licensed contractors to con-
slruct 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) (lcensed pursuant to the Contractor's License Law.)
❑ I am exempt under Sec B. 8 P.C. for this reason
Estimated Valuation
- I
PERMIT
-
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
$30.00
Mech.
Electrical
Plumbing
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.)
Policy No. Company
❑ Copy is filed with the city. O Certified copy is hereby furnished.
TOTAL
$30.00
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars (5100) valuation
or less.)
I certify that in the performance of the work for which this permit is issued, I shall not
employ any Parson in any manner so as to become subject to the Workers' Compensation
Laws of California
Date Owner
NOTICE TO APPLICANT: ff, 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.
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 -($101,000), 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
REMARKS
ZONE: BY:
Minimum Setback Distances:
Front Setback from C@ ter Line
Rear Setback from Re op. Line
Side Street Setb rm Ce rLine
Side Setback fro ope% Q
FINAL DATE INSPE
Issued by: Date
Validated by:
Validation: t
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
2ND FL. S0. FT.
POR. SO. FT. ®
GAR. SO. FT. ®
CAR P. SO. FT.
WALL SO. FT.
SO. 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
BONDING
FLOOR DRAIN
MECHANICAL FEES
FORMS
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APP.IEOUIP.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
TEMP. POLE
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
��
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1Ve c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ac
HOUSE SEWER
REMARKS:
VENTILATION
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 R AIR COND. SOLAR
SETBACK
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER SE
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP.IEOUIP.
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.jg
(/
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
Received From:
L . t C
Address:
C< (( t C" lr`i
('l �� 1 �• �- Date /-
n,
• Account No. E -Y .rI . �c2 ', �•
Lot(s)
T—
Service Address \ -
Tract
G.A. Code c—
❑' Meter(s)
-- --
❑ Service(s)
❑ Backflow(s)
❑ House Lateral(s)
❑ Detector Check(s)
❑ MeterSurcharge.
Capacity Charge
❑ W.S.B.F.C.
Temporary Construction Meter
. ❑ Turn on Charge
❑ Uncollected Account -Name
' ❑ Inspection Fee - Tract -
Fee -
❑ Plan Check Fees Water I Sewer -
Tract -
❑ Bond Payment - A.D. - Bond
Assmt.
❑ Customer Deposit
❑ Other
TOTAL $
Remarks:
❑Copy to:
!C4ash�------��_.�_
-- --
- Water Service
Cashier.
a.. CV W D— 438 (11189 )
Mailing Address: Box 1255 PALM DESERT, CA 92261
Phone: 328-6718 / 346-6916
Calif. State Contractors' License No. 310813
zZ, 00wner
Name OTenant Billto
Job at y At
City A � , ��— ap city Zip
—
N? 65783
DATE q t Z -�qr
WORKMAN �1//—
❑ Old Customer O New Customer
Classification
Telephone ( )
WORK AUTHORIZATION - I / We hereby authorize the work described along with
the necessary materials and parts
WORK ORDERED:
Time
From
To
Hours MATERIAL USED
AMOUNT
Mon.
Tues.
Wed.
Thurs.
Fd.
�2 L
Sat.
-
Sun.
T/
Total Hours
ENTERED
Invoice
Journal
Ledger
Cards
WAIVER OF RIGHT TO CANCEL
Having initiated a contract in connection with emergency
repairs or service for the immediate protection of persons or
real and persanaf properly, I hereby,state that the following
emergency situation exists, requiring immediate attention:
Pursuant to Section 1689.13 of the California Civil Code, I
agknowiedge and hereby waive all rights to cancel the sale
within three days.
Dated Buyer's Signature
TO OUR CUSTOMERS: Service men are required to have work slip signed. This Is done in order to protect you, the workmen, and ourselves, and
to enable us to give you absolute satisfactory service. You are respectfully requested to examine material and labor statement before workmen
leave the job, and if you find everything satisfactory, okay this ticket If service is unsatisfactory, in any wa , please phone our office
Immediately. I find the 6me and material charged above sabsfactay and agree to pay for same on presentation of rnvolos, and further agree to
pay reasonable charges for collecOrorl, including attorneys fees In the event of my default' A PENALTY WILL BE CHARGED AT THE RATE OF
11rz% PER MONTH ON UNPAID BALANCES AFTER 30 DAYS OF INVOICE DATE. ANNUAL PERCENTAGE RATE 18%.
Contractors are required by law to be licensed and regulated by
the Contractors.State License Board. Anyquestions concerninga Signed
contractor may be referred to the registrar of the board whose
address is: Contractors' State License Board, 9835 Goethe Road, BY
Sacramento, CA 95827, P.O. Box 26000, Sacramento, CA 95826.
Tom Material
Tax
Service
Permits- Insurance
Trucks -Equipment
TOTAL
Copyrlpht 1 M by John B. Raeres 6 son
Reeves susiNEssFoRms-owwamwD&*.Ctmrcty,cAt1=
Form 31 WAC