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BLDG (0201 015) + PLGB (14883)53875 Avenida Madero 0201-015 14883 LICENSED CONTRACTOR DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect. License # Lic. Class Exp. Date 46,9742 B 70/3110( Date Signature of Contractor OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractor's License Law for the following reason: 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, Business & Professionals Code). ( ) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business & Professionals Code). ( ) I am ampt under Section B&P.0 fo this reas Date I. 0 C ­ Signature of Own c ._ t.. WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: ( ) I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ( ) I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation insurance carrier & policy no. are: Carrier n. VAPT Policy No. (This section need not be completed if the permit valuation is for $100.00 or less). I certify that in the performance of the work for which this permit is issued, I ?;hall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that if I should become subject to the workers' compensation pro vsions-of Section 3700 of the Labor Code, I snail forthwith comply with those p %Qions) DaApplicant— Warning: Failure to secure Workers' Compensation coverage is unlawful and shall subject an employer to criminal penalties and civil fines up to $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. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on his application. 1. Each person upon whose behalf this application is made & each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this applicaton agrees to, & shall, indemnify & hold harmless the City of La Quinta, its officers, agents and employees. 2. Any permit Issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above Information is correct. I agree to comply with all City, and State laws relating to the building construction, and hereby authorize repres ntatives of this City to enter upon the above-mentioned provsrt ' r I spection ur ' ses. f Date Signature (Owner/Ag i) , ­ (t/. BUILDING PERMIT PERMIT# 0201 015015TRACT DATE VALUATION LOT JOB SITE APN ADDRESS 3.875 AWqW.'J.MI)n OWNER CONTRACTOR / DESIGNER / EN (NEER U"RTCid: DAVIDSON s3i W -R - BUILD.TiR .53-;'75 AMMAhAI RU LA QT)1n A i 1 - CMIJ) 5954 USE OF PERMIT 1Wg4X1UU L. BU1L DLt4C 90 IJ7. COMBO WA.11, T AX`TAiNJV1 Q b' 41ARI JEN, CITY 3TANf)AR73 6 Irr. WALL 80.00 LIF pll t2IC3'b.' FIX SU M"v 0.014MUCTION YBE 10) -Ow-t 18- 000 WAD Je JAN 04 2002 WYOFLAOUNFA FMAWAOM. ' 81M-XY'AL C`.0>)ti3'57'Ii.Ut"IIUN AND PI-W0WICK $41.00 RECEIPT DATE BY It' I DATE FINALED INSPECTOR I ­/ - 1 k INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings Ducts Slab Grade Return Air Steel Combustion Air Roof Deck Exhaust Fans O.K. to Wrap F.A.U. Framing Compressor Insulation Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath Final Final BLOCKWALL APPROVALS POOLS - SPAS Steel Set Backs Electric Bond Footings Main Drain _ Bond Beam Approval to Cover Equipment Location Underground Electric Underground Plbg. Test Fin2l Gas Piping PLUMBING APPROVALS Gas Test Electric Final Waste Lines Heater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection Encapsulation Gas Piping Gas Test Appliances Final Final Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole Underground Conduit Rough Wiring Low Voltage Wiring Fbdures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) COMMENTS: OWNER/BUILDER INFORMATION Dear Property Owner: An application fora building permit has been submitted in your name listing yourself as the builder of the property improvements specified. For your protection you should be aware that as ''Owner/ Builder" you are the responsible party of record on such a permit. Building permits are not required to be signed by property owners unless they are personally performing their own work. If your work is being performed by someone other than yourself, you may protect yourself from possible liability if that person applies for the proper permit in his or her name. Contractors are required by law to be licensed and bonded by the State of California and to have a business license from the City or County. They are also required by law to put their license number on all permits for which they apply. If you plan to do your own work, with the exception of various trades that you plan to subcontract, you should be aware of the following information for your benefit and protection: If you employ or otherwise engage any persons other than your immediate family, and the work (including materials and other costs) is $200.00 or more for the entire project, and such persons are not licensed as contractors or subcontractors, then you may be an employer.. If you are an employer, you must register with the State and Federal Government as an employer,and you are subject to several obligations including State and Federal income tax withholding, federal social security taxes, worker's compensation insurance, disability insurance costs and unemployment compensation contributions. - There maybe financial risks foiFou-if you do not carry out these obligations; and"iheselrisks are especially serious with respect to worker's compensation insurance. For more specific information about your obligations under Feder4l Law, contact the Internal Revenue Service (and, if you wish, the U.S. Small Business Adminstration). For more specific information about your obligations under State Law, contact the Department of Benefit Payments and the Division of Industrial Accidents. If the structure is intended for sale, property owners who are not licensed contractors are allowed to perform their work personally or through their own employees, without a licensed contractor or subcontractor, only under limited conditions. A frequent practice of unlicensed persons professing to be contractors is to secure an "Owner/Builder" building permit, erroneously implying that the property owner is providing his or her own labor and material personally. Building permits are not required to be signed by property owners unless they are performing 'their own work personally. Information about licensed contractors may be obtained by contacting the Contractors' State License Board in your community or at 1020 N. Street, Sacramento, California 95814. Please complete and return the enclosed owner -builder verification form so that we can confirm that you are aware of these matters. The building permit will not be issued until the verification is returned. Very truly yours, CITY OF LA QUINTA DEPT. OF BUILDING AND SAFETY 78-495 Calle Tampico La Quints,CA 92253 (760) 777 - FAX: 0 7-7 1 - OWNER'S SIGNATURE/DATE Y 53 _g 7 s PROPERTY ADDRESS oaol - oi5 PERMIT NUMBER(s) Certificate of Compliance: Residential (Page i of 2) CF4R Z-- ProjectTWe Date . '-38 75 AvE,tJinA 1Vqr,>45w4, Project Address John H. Hacker (619) 327-4565 Building Pamit # Doeumentattou Author Telepbooe Point System 15 Ch`dCedByfDate compuance Method 0%ckme, Point Sym or Computer) ts'7tmate Zone Enforcement Agcy Use only GENERAL INFORMATION Total Conditioned floor Area: ' fo Building Type: Single Family Hotel/Motel (check one or mon) Multi -Family (less than 4 stories) _7Z Addition Multi -Family (4 or more stories) Existing -Plus -Addition Front Entry Orientation: orth East / South / West / All Orientations (circle one or more) Number of Dwelling Units: Floor Construction Type: Slab / Raised Floor (circle one or both) Infiltration Control: Stand ight (circle one) 1 FESS/p BUILDING SHELL INSULATION Component Insulation Location/Cbmments 'CO Type R -Value (attic, to garage, typical, etc.) CM a wall .............. R— 19 Frame Walls 3,41-03 Wall .............. Roof ............. -R-3 U Typical cljA CIVIL Roof ............. ` Floor ............. rF F CAI Floor ............. Slab Edge ..... 0 GLAZING Shading Devices Glazing Area GlassType Interior Exterior Overhang Framing Type (d) (single, double) (roller blind, etc.) (shadescmen, etc.) (yesino) (metal/wood) _Orientation Front.... (11/) Double holler Blinds* None Yes Metal Front.... ( ) Single Leh...... (E) O Double Roller Blinds* None Yes Metal Leh...... ( ) Single Rear..... (3) — T Double Roller Blinds* None Yes Ketal Rear..... ( ) Single - Right.... (k4 Q Double Roller Blinds* None Yes Metal Right.... ( ) Single Skylight....... Skylight....... Double None or vertical/mini blinds THERMAL MASS off-white Type/Covering Area Thickness (slablexposed, tile, etc.) (so {inches) Location/Description (kitchen bath, etc.) Slab/Exposed ZOD 31 Kitchen/Bath/Entry Certificate of Compliance: Residential (Page 2 of 2) .CF -IR Pro)edl Title tate HVAC SYSTEMS Minimum' Duct Type (tumaoe sir Efficiency Location Duca "Output Manufacturer/Model# eonditioner.>heat ) (SE.SEERXSPF) (attic,etc.) R -Value tuh ora roved al Fwasm Awr ATTIC 4V H ,*r i AIR-COND. M4#0 ATTIC J=& ooyy W*t, i- A& /r 1itJ4,44- LIMIT /i"ooE L Maximum Furnace Heating Output: A SV0 Btuh HOT WATER SYSTEMS Tank Manufacturer/Model# System Type (storage gas, etc.) Capacity (or approved equal) Special Feature(s) STD. GAS 50 GAL. OR LESS APPROVED MODEL SPECIAL FEATURES/REMARKS (Add extra sheets if necessary) .. COMPLIANCE T TEMENT This certificate of compliance lists the building features and performance specifications needed to Comply with Title 24, Chapter 2-53 and Title 20, Chapter 2, Subdhapter 4, Article 1 of the California Administrative code. This certificate has been signed by the individual with overall design responsibility and the building owner, who shall retain a Dopy of it and transmit the certificate to any subsequent purchaser of the building. When this certificate of compliance is submitted for a single building plan to be built in multiple orientations. all building Conservation features which vary are indicated in the Special Features1kemarks section. Designer j Building Owner 'Mame: ! "Name: Tide/Firm: , "Title/Firm: Address: Address: Telephone: Telephone: ' LSc.: (signature) (date) (signature) (date) Documentation Author Enforcement Agency Name: JOHN E. IHACPER Nwne: Title/Firm: JOHN H. HACKER b ASSOCIATES Agency: Address: 4501 E. SUNNY DUKES ROAD, #D Telephone: PALM SPRINGS, CA 92264 - Tele ne• 6 ) 327-4565 (ci nn rt) (da,-, ) (64naturt or SW,) (dati) q1P Mandatory Measures Checklist: Kesidential AU 1K NOTE: Lowrise residential buildings subject to the Standards must contain these measures regardless of the compliance approach used. Items marked with an asterisk (•) may be superseded by more stringent compliance requirements listed on the Certificate of Oomplianoe. When this checldist is incorporated into the permit documents, the features noted shall be considered by all parties as binding minimum component perfofrnance specifications for the mandatory measures whether they are shown elsewhere in the documents or on this checklist only. DESCRIPTION DESIGNER I ENFORCEMEi•TI' Building Envelope Measures • 12-5352(a): Minimum ceiling insulation R-19 weighted average. 12-5352(b): Loose fill insulation manufacturer's labeled R Value. • §2-5352(c): Minimum wall insulation in framed walls R-11 weighted average (does not apply to exterior mass walls). ✓ 62-5352(k): Slab edge insulation - water absorption rate no greater than 03%, water vapor transmission rate no greater than 2.0 perm/mco. 01 A 12-5311: Insulation specified or installed meets California Energy Commission (CEC) quality . standards. Indicate type and fair. V/ §2-5352(f): Vapor barriers mandatory in Climate Zones 14 and 16 only. N A §2-5317: Infiltration/Exfiltration Controls a. Doors and windows between'conditioned and unconditioned spaces designed to limit air leakage. b. Doors and windows certified. c. Doors and windows weatherstripped; all joints and penetrations caulked and sealed. §2-5352(e): Special infiltration barrier installed to comply with §2-5351 meets CEC quality standards. ✓ §2-5352(d): Installation of Fireplaces ` 1. Masonry and factory -built fireplaces have: a. Tight fitting, closeable metal or glass door b. Outside air intake with damper and control c. flue damper and control 2. No continuous burning gas pilots allowed HVAC and Plumbing System Measures §2-5352(8) and 2-5303: Space conditioning equipment sizing: attach calculations. §2-5352(h) and 2-5315: Setback thermostat on all applicable beating systems. • 12-5316(a): Ducts constructed, installed and insulated per Chapter 10, 1976 UMC. §2-5316(b): Exhaust systems have damper controls. §2-5314(c): Gas-fired space heating equipment has intermittent ignition devices. §2-5314: HVAC equipment, water beaters, showerheads and faucets certified by the CEC. §2-5352(1): Water beater insulation blanket (R-12 or greater) or combined interior/exterior insulation (R-16 or greater); first 5 feet of pipes closest to tank insulated (R-3 or greater). ✓ §2-5312(Exception 1): Pipe insulation on steam and steam condensate return & recirculating piping. I A §2-5318(d): Swimming Pool Heating 1. System has: a. On/off switch on heater. b. Weatherproof instruction plate on heater. c. Plumbed to allow for solar. 2.75 percent thermal efficiency. 3.Pool cover. 4.Time clock. 5. Directional water inlet. Lighting and Appliance Measures ✓ 12-53520: Lighting - 25 lumens(wau or greater for general lighting in kitchens and bathrooms. ✓ §2-5314(c): Gas fired appliances equipped with intermittent ignition devices. ✓ 12-5314(a): Refrigerators, refrigerator -freezers, freezers and fluorescent lamp ballasts certified b), the CEC. Indicate make and model number. ✓ Form Rriscd De=nFr:19F, JOHN H. HACKER, CIVIL ENGINEER, PALM SPRINGS 327-4565 NAME ------- EDWARD P MILLER ADDRESS ---- 53B75 AVENIDA MADERA DATE ------- JUNE. 25 1992 MANUAL J FOR HEATING AND COOLING LOSSES AREA BLDG 462 SCS. FT. PERIMETER 51.33333 'LIN. FT. INSULATION! R VALUES .FLOOR G ..CEILING 30 ..WALL 1' —DUCT 4. AREA NORTH WINDOWS U S[!.FT. PERCENT OF AREA 0 AREA EAST WINDOWS O SOFT. PERCENT OF AREA 0 AREA SOUTH WINDOWS 96 SC . FT . PERCENT OF AREA 0 . 7 92 AREA WEST WINDOWS 6 SOFT. PERCENT OF AREA 0 AREA SKYLIGHTS 0 SOFT. PERCENT OF AREA 0 TOTAL WINDOW AREA 96 SO. FT. PERCENT OF AREA 20.77922 THE U VALDE OF THE WINDOWS IS .65 DUAL PANE SOUTH OVERHANG LENGTH INTERIOR THERMAL MASS AREA = 200 SO F-. A; ILTRATIOh'(STD 0.01a, MED 0.014, TIGHT 0.012) - .0 13 HEATING LOSSES FOISTING LOSSES... 178.293 BTU CEILING LOSSES'... 454.6667 BTU WINDOW LOSSES.. 1934.4 BTU :ALL LOSSES.... 475.8374 BTI: INFILTRATION LOSSES... 2062.368 BTU TOTAL HEAT LOSSES 0B/HR.. 6709. 566 GAS FURNANCE SIZE 20342.43 BTU OR 45,000 BTU COOLING LOSSES FOOTING LOSSES... 706.5778 BTU CEILING LOSSES... 586.6667 BTL! WINDOW LOSSES... 9120 PTU WALL LOSSES.... 613.5837 BTU INFILTRATION LOSSES... 887.0401 BTU NO. OF PEOPLE. 5 COOLING LOSSES..v 2000 KITCHEN... 1500 BTU DUCT LOSSES INCLUDED IN TOTAL TOTAL COOLII'G LOSSES(SEMS) 17246.35 BTU PO qT s YSTEM SUMMAP.Y: CL IMATE ZONE 15 P -2R ' PROJECT TITLE=EDWARD P MILLER DATE=JUNE 25 1992 JOE SITE=53875 AVENIDA MADERA BUILDING DATA CONDITIONED FLOOR AREA= 46= NUMBER OF STORIES= 1 SLAB/RAISED FLOOR SLAB TOTAL GLASS AREA 96 SOFT %GLASS 20.779 CHECK ALL APPLICABLE UNIT TYPE CONDITION(S) (X:) SINGLE FAMILY DETACHED (SFD) ( ) ADDITION ALONE !: SINGLE FAMILY ATTACHED (SFA? ( ) EXISTING BUILDING !: ) MULTI -FAMILY (MF:) ( ) EXISTING-PLUS—ADDITION SCORE CARD MEASURES POINT SCORES T 2.WALL INSU. 19 ) 3.RA-SED FLOOR INSU 0 !i 4. SL AE. EDGE INSU ) it 5.IAFILTR ATr eSTANDARD 0 & GLASS HEAT LOSS DUAL PANE U=. .65 -6 SUM C-80 (SHADE OPEN) SC= .6776 B. EAST 0 X E776 = 0 != D. SOUTH 20.77922 X .6776 = 14.08 -4 E. WEST ST 0 X .6776 = 0 -1 H.' SKYLIGHT it 77 = 0 0 S. SHADING (SHADE CLOSED) SC= .2552 A. NORTH 0 X .2552 = ,_, 1 B. -EAST .0 X .2552 = 0 4' C. SOUTH 20. 77922 X .2552 = 5.302857 -17 D. !JEST 0 X .2552 _ 0 E, E. SKYLIGHT 0 X .77 - C) Cr 9. INTERIOR THERMAL MASS 5.194805 5 10. EXTERIOR WALL MASS r) C; SUM 7-10 -10 =(-E .) 1 1 . HEATING SYSTEM .72 S.E. X.E!2= .5904001 Cr 1L. COOLING SYSTEM C -EER X*--= 13 'ir'-•iTER HEATING G.G. TOTAL POINTS Q GLASS AREA 0 96 C) 0 X GLASS i; 0 20.77922 0 4 P.O. BOX 1504 No. 14883 Building 53-8-15 Ave. Madero 78-495 CALLE TAMPICO Address LA OUINTA, CALIFORNIA 92253' Owner Miller Mary G. Mailing Address Same BUILDING: TYPE CONST. A.P. Number Legal Description Project Description OCC. GRP. Sewer Connect City La Quinta,, C, Zip i 92253 Tel. Contractor Tri—Star Construction .Address P.O. Box 542 City Cathedral Ci Zip y, CA 9223 ' el.321-0898 State Lic. & Classif. A $75515 City Lic. # &62 Sq. Ft. Size No. No. Dw. Stories Units Arch., Engr., Designer New ❑ Add ❑ Alter ❑ . Repair ❑ Demolition ❑ Address Tel. City Zip State Lic. # LICENSED CONTRACTOR'S DECLARATION hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section T000) of Division 3 of the Business and Professions Code, and my license is in full force and -SIGNATURE / DATE OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractors License Law for the following reason: (Sec. 7031.5,Bustness and Professions Code: Any city or county which requires a permit to construct, atter, 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 rive 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) #tensed pursuant to the Contractor's License Law.) O 1 am exempt under Sec. B. & P.C. for this reason Estimated Valuation $1,200.00 PERMIT AMOUNT. Plan Chk. Dep. Plan Chk. Bal. Const. ' Mech. - Electrical Plumbing 30.00 S.M.1. 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 Workers Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.) Policy N Company C%do—py is filed with the city. ❑ Certified copy is hereby furnished. TOTAL 30.00 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 anyperson 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 youshould 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 ($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 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 Cen Rear Setback from Rear Side Street Setback fr Side Setback from P/Wm FINAL DATE Issued by: Validated bv: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBIW GSFS IST FL. SO. FT. ® $ 2ND FL. SQ. FT. p POR. SO. FT. ® GAR. SQ. FT. ® CAR P. SD. FT. WALL SO. FT. ® SO. FT. ® ESTIMATED CONSTRUCTION VALUATION $ UNITS MOBILEHOME SVC. POWER OUTLET T YARD SPKLR SYSTEM BAR SINK ROOF DRAINS a 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 APPJEQUIP. LAUNDRYTRAY 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. SQ. FT. ® c BATH TUB ✓ 1011"a tom ( FINAL INSP. SQ. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. %.SQ. FT. RESID ® 1'A c SEWAGE DISPOSAL SO.FT.GAR ® 3/ac 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 SEW OR ROUGH WIRING DUCTWORK ROCK STORAGE FOUND. REINF. GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APPJEQUIP. REINF. STEEL GAS (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM GRADING cu. yd. $ plus x$ _$ LUMBER GR. ✓ 1011"a tom ( 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 SIONATURESJINITIALS GARDEN WALL FINAL COACHELLA VALLEY WATER DISTRICT CASH RECEIPT DETAIL .r Received From: Address: Account No. LPV ( • 3 ( ( • O ' Lot(s) Service Address 'a't -2 h C t'l t d t— .0 n d y- .µ Q41 ❑ Materiel Water Service • Money ❑ Service(s) _ Order`-OVWD-r791tves) ❑ Backflow(s) ❑ House Lateral(s) ❑ Detector Check(s) ❑ Meier Surcharge enitation Capacity Charge _ TS ❑ W.S.B.F.C. ❑ Temporary Construction Meter ❑ Tum on Charge ❑ Uncollected Account - Name ❑ Inspection Fee -Tract - Fee ❑ Plan Check Fees Water I Sewer - Traci - ❑ Bond Payment - A.D. - Bond Assmt. ❑ Customer Deposit ❑ Other Remadts- tV-% V.- . (LA 11-7 Tract- G.A. Code S W. 8i iso 31 . ►Rs TOTAL $ I `r • " V ❑Copy to: Cash Check .µ Q41 Water Service • Money Cashier Order`-OVWD-r791tves)