PLBG (14869) + RPL (06387)P.O. BOX 1504 No. 14869
Bu ng s2-'661 Ave, Mendoza 78-495 CALLE TAMPICO
Adiss I LA QUINTA, CALIFORNIA 92253
Owner Jay & Debbie Ca13in
Mailing BUILDING: TYPE-CONST. OCC: GRP.
Address Same
A.P. Number
CityZip Tel.
ZA Qislntas CA . 92253 564--2261 Legal Description
Contractor Sewer'Connect
Owner/Builder Project Description
Address. .
City Zip Tel.'
YState Lic. City
& Classif. Lic. # Sq. Ft. No. No. Dw.
Arch., Engr., Size Stories • - Units
Designer New ❑ Add ❑ Alter ❑ Repair ❑. Demolition ❑
Address Tel.
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
1 hereby affirm that I am licensed under Provisions of Chapter 9 (commencing with Section
tot of Division 3 of the Business and Professions Code, and my license is in full force and
effec- -
.SIGNATURE DATE _
OWNER-BUILDER DECLARATION Estimated Valuation
I hereby affirm that I am exempt from the Contractors License Law for the following';i3V • ��
reason: (Sec. 7031.5,Business and Professions Coder .Any city or county which. requires a
permit to construct, after, 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 PERMIT - AMOUNT -
the provisions of the Contractor's License Law, Chapter- 9 (commencing with Section 7000) of
Divlslon 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 Plan Chk. Dep. -
subje s,the applicant to a civil penally of not more than five hundred dollars ($500). • - - -
� as owner of the property, or my employees with wages as their sole compensation, will Plan Chk. Bal. '
do the work, and the structure is not Intended•or offered for sale. (Sec. 7044, Buisness and CpnSt. '
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, Mech. t'-'
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 Electrical
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. Plumbing 30.00
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 S.M.I. -
• such projects with a contractors) licensed pursuant to the Contractor's License Law.) _
❑ I am exempt under Sec • B. & P.C. for this reason Grading
Driveway Enc.
Date X56- 937-Owner ~ Infrastructure
J ✓ _
WORKERS' COMPENSATION DECLARATION
I hereby affirm that 1 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-.130 -
CERTIFICATE OF EXEMPTION FROM REMARKS
WORKERS' COMPENSATION INSURANCE
(This section need not be completed If the permit is for one hundred dollars ($100) valuation
or less.)
I certify that in the performs ce of thg work for which this permit is issued, I shall not '
employ any person in any man er so as to become su jeet to the Workers' Compensation
Laws ot"Callfor
�+✓Owner
NOTICE TO APPLICANT.- d. aofmaking this Certificate of Exemption you should become , ZONE: • BY:
::s�ubject to the Workers' • Compensation provisions of the Labor Code, you must forthwith
•comply with such provisions or this permit shall be deemed revoked. ,Minimum Setback Distances.
Front Setback from Center Line
Rear Setback from Rear Prop. L' "
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND Side Street Setback from Cen ne x
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, Side Setback from Property
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND a t
ATTORNEY'S FEES. i
his is abuildin FINAL DATE
TINSPEC
g permit when properly filled out, signed and validated, and is subject to • t � •` 3
expiration if work thereunder is suspended for 180 days.F.
9 f
I certify that I have read this application and state that the above information is *correct. Issued by: • Date •PermiT'
I agree to comply with all city and county ordinances and state Aaws relating to building
construction, and hereby authorize representatives -of this city to .enter the above-. Jai a s " t� i, 1,go
mentioned property for inspection purposes. . . Validated by:r y •f o
Signature of applicant Date'
..Mailing Address Validation: .. * `��`•
City, State, Zip
. .. ,_ i-AV"t
,�:' tel!
!�"'
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING: FEES 1
IST FL. SO. FT. ® $
UNITS
SLAB GRADE
2ND FL. SO. FT. p
BONDING
YARD SPKLR SYSTEM
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SO. FT.
GAS (ROUGH)
DRAINAGE PIPING
WALL SO. FT.
OTHER APPJEOUIP.
DRINKING FOUNTAIN
SO. FT. ®
TEMP. POLE
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GROUT
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SYSTEM
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FRAMING
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
REMARKS:
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
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
ROUGH WIRING
DUCT WORK
ROCKSTORAGE
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.
��/� �% l FINAL INSP.
FRAMING
FINAL INSP. may/ OF
f7 JJ
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
COACHELLA VALLEY WATER DISTRICT
CASH RECEIPT DETAIL 46320
-501 .22,(Qj Data- /0
C. - LI do, 2s,,) A )e 168/
Received From: CA 12—
, 04&64,Zb?-A e -
Address: AVE - 4A el- 4 C100- 7Z=Z—_�
I i 70'G-0.60t(s). C2 Tract -:5 C_ 8 Lk 1 21
Service Address Sa - &C, US OM E1,06 Z4 G.A. Code
0 Mefer(s)
0 Service(s)
11 Backflow(s)
0 House Lateral(s)
0 betbct&Check(s)
0Meteurchirge
0 - '1 77 -2
eltatl
O' ;aniton Capacity Charge
0 W.S.B.F.C.
0 Temporary Consirucilon Meter
0 Tum on Charge
0 Uncollected Account - Name
—
0 Inspection Fee - Tract -
Fee -
O Plan Check Fees Water I Sewer -
Tract -
El Bond Payment - A.D. --Bond
Assmt.
0 Customer Deposit
0 Other
TOTAL 7 -a -
Remarks: CU:fWVvNT tz- Lo ILL 6Qj Nr, Shck QT-M7&A)
A FTT_� 14 q- MOTA-111-S
D COPY to:
Cash
Water Service
Check
5W
Money Cashier
Order CVWD-438 (11/89)
VALLEY WIDE PUMPMC34 SERVICE
100 S. Sunrise Way Suite 133
PALM SPRINGS, CA 92262
(619) 322-2400 (619) 347-3545
"YOUR WASTE IS OUR PROBLEM"
SOLD BY�
u
NAME/
i �^ L
ADDRESS -
PHONE
c-
w CHARGE r r F°Y MERCHANE ISE RETURNED r r MV s 1,
rsn�'❑ CASH ❑ '� ❑
?� +�# r2"r+`.>. �'r�
'fir
Q,CO.D4fsv. ,. tti`❑ PAIO:OUT?+'9-QPAID ON ACCOUNTn��fi :c;%'!
OTY.
DESCRIPTION
PRICE
AMOUNT
0a r
2
✓ f �—
3
iii i:, :.„- -: ' )f.,: • !�':.'
i
�
4
__((✓
2'_
5
7
8
9
10
: ,_,: t 26'
12
13
14
THIS BILL MUST BE PAID WITHIN 7 DAYS
15
OF INVOICE DATEOR 1%% INTEREST WILL.
BE ADDED.
16
RECEIVED BY
TOTAL
/ •_ -r� •�
4762THANK YOU
Contents: 40% Pre -Consumer• 101% Post -Consumer
T4ht 4 4 Q"
P.O. BOX 1504
Building78-105 CALLE ESTADO
Address 52-661 Mendoza LA QUINTA, CALIFORNIA 92253
Owner
Mailing
Address
City Zip Tel.
La Quints 1 92253 564-2251
F 6 F
Address
78-755
State Lic. I City
& Classif. 476807 Lic. # • 130
Arch., Engr.,
Designer
Address Tel.
CityI Zip I State
Lic. # r
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
MCI
Division 3 of the Business and Professions Code, and my license is in full force and
effect
SIGNATURE DATE
OWNER -BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,8Usrless and Professions Code: Any city or county which requires a
Permit to constnrct, ager, improve, demolish, or repair any structure, prior to its issuance also
requires the appicamt for such perms to fele a signed statement that he is licensed pursuant to
the provsions of the Contractors License Law, Chapter 9 (commencing with Section 7000) of
Division 3 of the Business aid Professions Code, or that. he is exempt therefrom, and the basis
for the areged exemption. Any violation of Section 7031.5 by any applicant for a permit
subjects :ant to a ch4 penally of no more than five hundred dollars (5500).
❑ 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 Contractors License Law does not apply to an owner of property who
bolds or improves thereon and who does such work himself or through his own employees,
Provided tiud such improverneds are not intended or offered for sale. n, however, the building
or improvement is sold wild one year of completion, the owner -builder will have the burden
of provkg that he did not buil or irpmove 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 appy to an owner of Property who builds or improves thereon, and who contracts for
such projects with a contractorfs) licensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec_ R. & P.C. for this reason
Date owner
WORKERS' COMPENSATION DECLARATION
I hereby affrrn that 1 have a certificate of consent to self -insure, or a certificate of
Workefs Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No impar y
❑ Copy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed 9 the permit is for one hundred dollars ($100) valuation
or less.)
1 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: 9, after maki g this Certificate of Exemption you should become
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
campy with such provaons or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
Ihereby 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 Naar
Lenders Address
This is abuilding permit when property filled out, signed and validated, and is subject to
expiration if work thereurufer is suspended for 180 days.
1 certify that 1 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
No. 06387
BUILDING: TYPE CONST.
A.P. Number
Legal Description
Project Description
OCC: GRP.
773-M-019
Pool
Sq. Ft.
Size
No. No. Dw.
Stories Units
New ❑ Add ❑
Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
400
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
$ 89.20
Const.
108.00
Mech.
30.00
Electrical
2HOP
Plumbing
24.00
S.M.I.
.63
Grading
Driveway Enc.
Infrastructure
TOTAL
,%t"' f`,'.
REMARKS
_ ,n
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
9/22/89
Issued by: Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
SLAB GRADE
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL SQ. FT.
FORMS
SEWER OR SEPTIC TANK
/UGH WIRING/��,J
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
GAS (ROUGH)
METER LOOP
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
GAS (FINAL)
TEMP. POLE
DRAINAGE PIPING
CARP. SQ. FT. ®
GROUT
WATER HEATER
WALL SQ. FT.
FINAL INSP.
DRINKING FOUNTAIN.
SQ FT ®
WATER SYSTEM
FINAL INSP.
URINAL
ESTIMATED CONSTRUCTION VALUATION $
=$
WATER PIPING
NOTE: Not to be used as property tax valuation
ROOFING
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
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
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/. c
SEWAGE DISPOSAL
SO.FT.GAR ® V4c
HOUSE SEWER
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 PLUMBI
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
/UGH WIRING/��,J
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
FINAL INSP.
FINAL INSP.
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
FRAMING
ROOFING
6J �� I' /� �—
�
2 / s l &4
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
1