PLBG (12215)J.
Building '
Address •53 -671 Mendoza
Ow Vim Cit c,a_ rt
Mailing .
Address '' .-419.95 ,136ardwalk
City Zip
Palm eitj 92260
• I
P.O. BOX 1504
78-105 CALLE ESTADO ,
LA QUINTA, CALIFORNIA 92253
.y-
BUILDING: TYPE CONST
,564-41(14
Contractor
R.V. sa.; P-1111 3in /Rick
S evvinson
Address
requires the applicant .for such permit to file a signed statement that he is licensed pursuant to
PERMIT
741.10 Veilardo Drive
'
City
-,pa3m
•- •. ': --.Zip
DeserL
X2264
Plan Chk. Bal.
Tel.:
341-9224
State Lic.
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and
COr1St.
City
& Classif.
.36 60. 2396
Mech.
Lic. # 2325
Arch Engr
or improvement is sold within one year of completion, the owner -builder will have the burden
Electrical
of proving that he did hot build or improve for the purpose o/ sale.)
r
Designer
Address Tel.
City Zip State
`�•.' _ Lic.#
�.
•iF I S`EDCf�,`NTRACTOR'S��,D,ECLARATION
I hereby affirrrp tsed unfler provisioljs'Af Chapter 9 Ice
mencing with Section
Ise is in full force and
A.P. Number
e+
Legal Description
Project Description Sewer Connect
Sq. Ft. No.
Size Stories
No. Dw. �>
Units -s
INew ❑ Add ❑ Alter ❑. Repair ❑
` "r 1.r1'! - ^. OWNER -BUILDER DECLARATION
I hereby affirm. that 1'am exempt from the Contractors License Law for the following
reason: (Sec. 7031'5; Business and Professions Code,' Any city oricounty which requires a
permit to construct,'• alter, � improve,' demolish,'or repair any structure, l prior, to Its issuance also
Estimated ValUatF
requires the applicant .for such permit to file a signed statement that he is licensed pursuant to
PERMIT
the provisions of the -Contractor's License. Law, Chapter 9 (commencing' with Section 7000) of
'
Division 3 o/ the Business and 'Professions Code, or that. he is exempt therefrom, and the basis
for the alleged exemption. Any violation Section 7031.5 by 'any for
Plan Chk. Dep.
of applicant a permit
subjects the applicant to a civil penalty of not more than five hundred dollars ($500).
Plan Chk. Bal.
❑ 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
COr1St.
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.
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 hot build or improve for the purpose o/ sale.)
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-
Plumbing
struct the project: (Sec. 7044, Business and Professions Code: The Contractor's License Law
Demolitiori ❑ .
0000.00
AMOUNT
• iJi!
• doesnot apply. to an owner of property who builds or improves thereon, and who contracts /or .S.M•1.
such projects with a•contractor(s) licensed pursuant to the Contractor's License Law.) -•
Grading
❑ 1 am exempt under_Sec. B. & P.C. for this reason
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. ` 0 Certified copy is hereby furnished.
f ,
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURA�NCV
(This section need not, be - completed if the per t is /or one un ed dollars OJ valuation
or less.)?' - . �
I certify that in the performance" @ w k for which tt4 permit is issLed, 1 shall not
employ any pers in any man r as o ecome ubject t t e o s' Compe S�1bn
L'awCaliforn % t
Da ` Owner,
NO E TO AP ICANT:` Il, her a t is Certilic of Ex mption. you should b co e
subject to the Workers' Co sation ovisions of the Labor Code, you must forthwith
comply with such provisions or this permit sh I 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. 3 09 7, 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
Mailing Address
.City, State, Zip
- 7
TOTAL �� •
REMARKS
ZONE: BY:
Minimum.Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
• Ate....
Side Setback from -Property Line
FINAL DATE INSP
,77TUR
0
Issued by: Date ml
Validated by: Al lP_
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
COLL. AREA
2ND FL. SQ. FT.
ROUGH PLUMB.
YARD SPKLR SYSTEM
FOR. SQ. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. I SQ. FT.
DUCT WORK
DRAINAGE PIPING
WALL SQ. FT.
GAS (ROUGH)
DRINKING FOUNTAIN.
SQ FT ®
HEATING (FINAL)
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GAS (FINAL)
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER HEATER
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
WATER SYSTEM
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
GRADING
cu. yd.
$ Plus -X$-=$
LAUNDRYTRAY
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.
SO. FT. ® c
BATH TUB
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/a c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ac
HOUSE SEWER
SPARK ARRESTOR
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE IPL.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
SEWERS. -TAW
C
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP./EQUIP.
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 SIGNATURES/INITIALS
_
GARDEN WALL FINAL
COACHELLA VALLEY WATER DISTRICT
CASH RECEIPT DETAIL
Received From: I G (�a���-_-•- / - Z�
G '.'" L !"<" Da
Address: —4/A �
Account No. Lot(s)
Trac G . d
Service Address
G.A. Code
❑ Meter(s)
$
❑ Service(s)
❑ Backflow(s)
❑ House Laterals)
❑ Detector Check(s)
❑ Meter Surcharge
Sanitation Capacity Charge,orS
O
❑ 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:
_
�m