9506 (PLBG)EgEAL APPROVAL PROM
(Ellie)
.V.F1.D•
? ) (:e4t,, 4
P.O. BOX 1504 N o . 95
Building 53-760 OBREGON 78-105 CALLE ESTADO
Address LA QUINTA, CALIFORNIA 92253 SEWER HOOKUP
Owner
KEN PINON & BRADLEY JONES ]BUILDING: TYPE CONST. OCC: GRP.
Mailing
Address SAFE
City Zip Tel.
LA QUINTA, CA 92253 1 —
RICK VICKERS STEVENSON
46757 SAN JUAN
City Zip Tel.:
PALM DESERT 92260 341-6546
State Lic. City
& Classif. 602396 Lic. #
Arch., Engr.,
Designer
Address
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000)16f Division 3 of thii;Business and Professions Code, and.mytlicense is in full force and
SIGNATLRE'" - ' ".. d - '�-- • DATE
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, alter, 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) of
Division 3 of Me Business and Professions Code, or that. he is exempt therefrom, and the basis
for the staged exemption. Any violation of Section 7031.5 by 'any applicant for a permit
subjects the apptcant to a civil penalty o/not more than rive hundred dollars ($500).
O 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 bnproves 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 buildor improve for the purpose of sale.)
❑ I, as owner of the property, am exclusively contracting with licensed contractors to corp '
strucl 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. 8 P.C. for this reason
Date owner
WORKERS' COMPENSATION DECLARATION
hereby affirm that I have'a certificate of consent to self -insure, or a certificate o
Work
efs 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
WORKERS'COMPENSATIONINSURANCE
A.P. Number
Legal Description
Project Description SEER HOOKUP
Sq. Ft. No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation $800.00
PERMIT
Plan Chk. Dep
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Driveway Enc.
Infrastructure
f
TOTAL
(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 thg work for which this permit is issued, I shall not
employ any pperson in any manner so as to become subject to the Workers' Compensation
Laws of.California.l f
Date •Owner 'f��r ! f / r t
NOTICE TO APPLICANT: g, 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.
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.) .
Lenders Name
Lender's Address
This is a building permit when properly filled out, signed and validated, and is subject to
expiration it work thereunder is suspended for 180 days. '
I certify that I have read this application and state that the above information is correct.
1 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
AMOUNT
$30.00
f)
REMARKS at hx g ra^f An 4/-134 r A- 4-.04 � {;
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
IST FL. SQ. FT. ® $
2ND FL. SQ. FT.
POR. SQ. FT. ®
GAR. SQ. FT. ®
CAR P. SQ. Fi.
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
BONDING
FLOOR DRAIN
MECHANICAL FEES
FORMS
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APPJEOUIP.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
TEMP. POLE
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.
SQ. FT. ® c
BATH TUB
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
/yQ
c 5 A,
SQ.FT.GAR ® 34c
HOUSE SEWER
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 & 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
/yQ
c 5 A,
REMARKS:
VENTILATION
FIRE ZONE ROOFING:
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION -
CERT. OCC:
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
I
Received From: J O t�4�S /�- 1E N �/4 y�/
Address: &&104-
COACHEL.LA VALLEY WATER DISTRICT
CASH RECEIPT DETAIL
77/— 057/1
L / r -rA
N. ,0371
Date: 7 -XV
`p? 7 7
Account No. 03,21134 0'
Lot(a)17
Tract
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Service Addreas S .. y� 2
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G.A. Code
OPo� div
C
5 0 �
72� s �- .�
O
$ 750 O
PlSenlce(a)
❑Copy to:
O Backflow(s)
'
❑ House Lateral(s)
O
,
❑ DetectorCheck(s)
Nn
Money
Order
❑ Met rSurcharge
' 3.-
15 -7,
I
CVWD-438 (11188)
� o
anitation Capacity Charge
❑ WS.B.F.C.
O Temporary Construction Meter
❑ Turn on Charge
O Uncollected Account - Name
❑ Inspection Fee - Tract -
Fee -
O Plan Check Fees Water I Sewer -
Tract -
O Bond Payment - A.D. - Bond
.: Aasmt.
E' O Customer Deposit
t•
�. ❑ Other
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TOTAL $ %
53.7
D DB OZE �O�/
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Remarks:
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OPo� div
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72� s �- .�
❑Copy to:
'
Cash
Check V
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,
Water Service
Nn
Money
Order
Cashier
I
CVWD-438 (11188)
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