10737 (PLBG)Building
Address 54-145 OBREGOR
Owner
RUBEN VAS®UE2
Ti4` la Q"
P.O. BOX 1504 V `N Q. 10737
78-105 CALLE ESTADO r
LA QUINTA, CALIFORNIA 92253
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Mailing BUILDING: TYPE CONST. OCC: GRP._
Address
A . Number
City Zip Tel.
LA QUINTA 1922530 1 564-2045
City
State Lic. City
& Classif. I Lic. #
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
7tof Division 3 of the Business and Professions Code, and my license is in full force and
effec
�GNATURE 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, demolish, or repair any structure, prior to fts.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 Caw, 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
subjycts the applicant to a civil penalty of not more than rive hundred dollars.($500).
jq+1, as owner of the property, or my employees with wages as their sole compensation, will
Yl0 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 or 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.)
❑ 1 am exempt under Sec. B. & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificatefofeconsent to,self-insure, or a certificate of
Worker's Comperisation Insurance, or a certified'copy thereof.,(Sec. 3800,. Labor Code )'
Policy No. / /// 17 ' Y CCom an J � �r _ '� ;e& ."
P �
❑ Cods fed with the city. ❑ Certified copy is hereby furnishe
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed ff the permit is for one hundred dollars ($100) valuation
or less.) f . . .
I certify that in the performance of the work for which this permit is issued, I shall not
rr
employ any'persoin any manner so as to become subject to the'Workers' Compensation
aws of California:
ru APPULANlarl{rader•making this Certificate of Exemption yourshould become
to the Workers Compensation provisions of the ,Labor Code you must forthwith
with such provisions or this permit shall be deemed revoked.,--_ f
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.)
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-
Mail! ' n
ateMailing Address
City, State, Zip
Description
t Description S EWER. HOOKUP
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:
Sq. Ft.
Size
No.
Stories
No. Dw.
Units
New ❑ Add ❑
Alter ❑ Repair ❑ 'Demolition ❑
Estimated Valuation
$200
PERMIT
AMOUNT'
Plan Chk. Dep.
Plan Chk. Bal
Const.
Mech.
Electrical
Plumbing
030.00
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
$30.00
REMARKS
y Oryry yy
y
AXQ
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
r
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
2ND FL. SO. 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
ROUGH PLUMB.
FLOOR DRAIN
MECHANICAL FEES
HEATING (ROUGH)
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
DUCT WORK
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
GAS (ROUGH)
LAUNDRYTRAY
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
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1 Vi c
SEWAGE DISPOSAL
LUMBER GR.
SO.FT.GAR ® 'Y.c
HOUSE SEWER
FRAMING
FINAL INSP /
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PLCK.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
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESiINR1ALS
GARDEN WALL FINAL
Y-
COACHELLA VALLEY WATER DISTRICT
CASH RECEIPT DETAIL
�
' Received From: ,.�%c J : .r �� i
f t i= A%
Date:
Address: �. G � /4
e -2l! `� .t �, -�a
A
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Account No..� ..� G, •�'' Lot(s) u
C.-• �•. t ..� �-_ y
Service Address �•� - e� `� �'
h (/�".. �J `�. ��7j
Tract
G.A. Code
❑ Meter(s)
$
❑ Service(s)
❑ Backflow(s)
❑ House Lateral(s)
❑ DetectorCheck(s)
❑ Meter Surcharge
V Sanitation Capacity Charge n'
1- 1
❑ 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
. o r
TOTAL $ i :7. 127.
Remarks:
❑Copy to:
Cash
'i
Water Service
Check i;
Money
j�.,.`i
)
,�
5'
+ i
Cashi
Order
1,r
CVWD-438 (11189)