PLBG (13184)P.O. BOX 1504 N o . 1,3184
Building 54-213 Mendoza LA QUINOTAC
Address CALIFORNIA 92253
Owner
Kelly Parker BUILDING: TYPE CONST. OCC: GRP.
Mailing
Add resse
A".P. Number _
City Z1"92253
Tel.
Quintap CA, Legal Description
Contractor Project Description Sewer Connect
WS' Plumbing/stick Stevenson
Address
74110" Ve.lardo
ikim s7Tt: ert,' Ip..92260 Te1341-x92,24
State Lic. City
& Classif. •C.36 602396 Lic. # 2932 Sq. Ft. No. No. Dw.
Arch., Engr.; Size Stories Units
Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address Tel.
City Zip State
Lic. #
r LICEN �0 COttTRACTOR'S DECLARATION
I,hereb of irm,that,l,am licensed ugqYder pro"Aigns,of Chanter 9 (commencing with Section
7000) of Division 3 of 1be;Busmess' o ess'o o d -e nd`my license is in full force and
Yffect. ,r ^a 1
SIGNATURE��'.i/•i^6y'/,:J. "'"r `.�.J DATE
"- OWNEFrBUILDER DECLARATION
I,hereby affirm that I am exempt from the Contractor's License Law for the following Estimated Valuation $11.000.00
n reason: (Sec. 7031.5,Business 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 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 �
Division 3 of the Business and Professions Code, or that. he is exempt therefrom, and the basis - 1
for the alleged exemption. Any violation of Section 7031.5 by 'any applicant for a permit Plan Chk. Dep.
subjects the applicant to a civil penalty of not more than five hundred dollars ($500). -
❑ I, as owner of the property, or my employees with wages as their sole compensation, will Plan Chk. Bal.
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and Const.
r
Professions Code: The Contractor's License Law does not apply to an owner of property who
builds or improves . thereon and who does such work himself or through his own employees, Mech
provided that such improvements are not intended or offered for sale. If, however, the building r
or improvement is sold within one year of completion, the owner -builder will have the burden ElectricalI
of proving that he did not build or improve for the purpose of sale.) 12 1r)onJUL i
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing I. J0.00
strucl the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law tE
does not apply to an owner or property who builds or improves thereon, and who contracts for S.M.I..b .1_
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
❑ I am exempt under Sec. B. & P.C. for this reason Grading y * ) r t
Driveway Enc. j
Date Owner Infrastructure,' J "
WORKERS' COMPENSATION DECLARATION �S £
I hereby affirm that I have a certificate of consent to self -insure, or a certificate of
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. Company
❑ Copy is filed with the city. ❑ Certified copy is hereby furnished.
TOTAL " • U�
CERTIFICATE.OFEXEMPTION FROM REMARKS
WORKERS' -COMPENSATION INSURANCE
(This section need not be completed if the permit islor on hundred dollars 100) valuation -
or less. ((�(�$
I certify that in the,p ormance o �thg rk f r7 h h this p rmif i ssiie�d, I shall not
employ any person in any mannerasRS'bec`ome s ec . - hV w6rRers' Cofipensation
Lawsof California.
Date
NOTICE TO, AP.PLICANT:-,ljf.�afte& ' g f is eralkate" btl6emphon u s_u beco ZONE: -v BY:
subject to the) Workers' Com`pen.p ioV provisions o/lt�Labor Code, you must forthwit Minimum Setback Distances: r b
comply with such provisions or this i7lit shall be deemed revoked.
!/ Front Setback from Center Line
Rear Setback from,Rear Prop. Line
CONSTRUCTION LENDING AGENCY Side Street Setback from Center Line
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.) Side Setback from Property Line
Lender's Name
Lender's Address FINAL DATE INSPECTOR
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. Issued by: Date Permit
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. Validated,by:
Signature of applicant Date
Mailing Address Validation:
City, State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SQ. FT. ® $
UNITS
jCOLL. AREA
SLAB GRADE
YARD SPKLR SYSTEM
2ND FL. SQ. FT.
HEATING (ROUGH)
= STORAGE TANK
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
DUCT WORK
j! i
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
METER LOOP
HEATING (FINAL)t
.
DRAINAGE PIPING
CAR P. SQ. FT.
REINF. STEEL
GAS (FINAL)
WALL SQ. FT.
DRINKING FOUNTAIN
SO. FT. ®
GROUT
URINAL
ESTIMATED CONSTRUCTION VALUATION $
FINAL INSP.
WATER PIPING
NOTE: Not to be used as property tax valuation
BOND BEAM
FLOOR DRAIN
MECHANICAL FEES
GRADING
cu. yd.
$ plus
x$ =$
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
FRAMING
WASHER(AUTO)(DISH)
APPLIANCE DRYER
ROOFING
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
REMARKS:
LAUNDRYTRAY
AIR HANDLING UNIT CFM
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
FIRE ZONE ROOFING
WATER CLOSET'
COMPRESSOR HP
POLE,TEMIPERMLAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
�, HOWER
BOILER B.T.U.
SO. FT. ®c
LATHING
ATH TUB
SQ. FT. ® c
=f
ATER HEATER'
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
t
-. SEWAGE DISPOSAL
SO.FT.GAR ® 3/.0
x
HOUSE SEWER.,_:
f -
GAS'PIPING
_
PERMIT FEE
CERT. OCC.
PERMIT FEE
t. ;
�,_ PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE
ELECT. FE
-". SMI FEE PLUMB. FEE
GARDEN WALL FINAL
STRUCTURE P),UMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
G1i,QUND PLUMBING
UNDERGROUND
A.C. UNIT
jCOLL. AREA
SLAB GRADE
ROUGH PLUMB.;.
BONDING
HEATING (ROUGH)
= STORAGE TANK
FORMS
et,,,18EWER
GH WIRING
DUCT WORK
j! i
»q:
:4 ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)t
.
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.
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 SIGNATURESIINITIALS
GARDEN WALL FINAL
COACHELLA VALLEY WATER DISTRICT qp® ' 4 1
CASH RECEIPT DETAIL �— 14[``
(� Date:—
Received From:
1 � � A
Address: 1
�—c
L �2. C�Tract`��6
i(
Account NoG osG.A. Code
eU
Service Address
❑ Meter(s)
❑ Service(s)
❑ Backflow(s)
❑ House Lateral(s)
❑ Detector Check(s)
❑ Meter Surcharge
4-19'anitation Capacity Charge
❑ 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
c , �
TOTAL $ 5 ' L C
Remarks:
❑Copy to: Water Service
rCheck
V ��i •_)•� Cashier
Money ' CV W LF 438(11/891
Order V
v