9857 (PLBG)Building
BBuilding
54-195 CARRAVZA
Owner
LOUISE L. GOOD
Address P 0 BOX 325
City Zip
. LA QI7I1+iiA,A 92253
Contractor
ECONO SEWER
Address
P 0 BOX 192
Tel.
P.O. BOX 1504 �-- N o .
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253 f jy
City Zip Tel.:
PALM DESERT 1 92261 346-2792.
State Lic. City
& Classif. 4509611 Lic. # - 342
Arch., Engr.,
Designer
Address Tel.
City I Zip I State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed;undei provisions of Chapter 9 (commencing with
7000) of Division 3 of the Buslness �anfd^Professions Code, and my license is in full,h
effect. .. A/1-1 "��s""" . / s ! 1
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
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 rile 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 five 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,' Suisness 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. ff. however, the building
or improvement is sold within one year of completion, the owner -builder wig 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) 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 acertificate 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 !s filed with the city. ' ❑ Certified copy is hereby fumished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed ff the permit is for one hundred dollars ($700) valuation
or less.)
I 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: ff, after making this Certificate of Exemption you should 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.
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
Mailing Address
City, State, Z!p
ILDING: TYPE CONST. SEWER ROCC�RRP.
A.P. Number
Legal Description
Project Description SEWER HOOKUP
9857
Sq. Ft.
Size
No.
Stories
No. Dw.
Units
New ❑ Add ❑
Alter ❑
Repair ❑ Demolition ❑
Estimated Valuation
$1,500
PERMIT
AMOUNT
Plan Chk.. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
$30.00
S.M.I.
Grading
Driveway Enc.
I of rastructure
TOTAL $30.00
-REMARKS t
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
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SQ. FT. ® $
UNITS
2ND FL. SQ. FT.
COLL. AREA
YARD SPKLR SYSTEM
ROUGH PLUMB.
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
HEATING (ROUGH)
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
ROUGH WIRING.
DRAINAGE PIPING
CAR P. I SQ. FT.
ROCK STORAGE
FOUND. REINF.
WALL SQ. FT.
DRINKING FOUNTAIN,
SQ FT ®
URINAL
ESTIMATED CONSTRUCTION VALUATION $
REINF. STEEL
WATER PIPING
NOTE: Not to be used as property tax valuation
TEMP. POLE
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.
SO. FT. ® c
BATH TUB
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 1% c
SEWAGE DISPOSAL
FIREPLACE
SQ.FT.GAR ® V4c
HOUSE SEWER
LATHING
MESH
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 APP.IEQUIP.
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
Zq,
REMARKS:
01
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
i
COACHELLA VALLEY WATER DISTRICT
CASH RECEIPT DETAIL
Received From: ....... ...... (100J., DateaKc-w—
Address: 60 C(&
Account No. t 'IC,) Ulf Lot(s) Tract 5 C
Service Addresses V-1 G.A. Code
0 Meter(s) $
k 0 ServIce(s)__
0 Backflow(s)
0 House Lateral(s)
0 Detector Check(s)
0 Meter Surcharge
Ip Sanitation Capacity Charge I
0 W.S.B.F.C.
0 Temporary Construction Meter
0 Turn on Charge
0 Uncollected Account - Name
0 Inspection Fee - Tract -
Fee -
0 Plan Check Fees Water / Sewer -
Traci -
0 Bond Payment - A.D. --Bond
Assmt.
0 Customer Deposit
11 Other
TOTAL
Remarks:
0 COPY to:
Cash
Check
Money
Order
-
jo,+ i t/ Water Service
Cashier—
C,VvvD4(11/89)
_,Ago
4
I