11033 (PLBG)r�
Building
Address 52-770 REHIO
Owner
NAH%EN
Address SAME
T4t�p 4.4 Qulk&
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
City
Zi
Tel.
LA QUIN?A
92253
I
Estimated Valuation
Contractor
RVS'PLUMBING/RICK STEVENSON
Address
P O- -BOX 692 RARCHO MIRAGE
City
Zip
Tel.:
RANCHO MIRAGEJ
92270
341-6546
State Lic.
City
& Classif. C36 302396
Lic. # 1914
Arch., Engr.,
Designer
Address
f Tel.
CityI Zip I State
Lic. #
my license is i/Nf/u�ll force.(— "
�41�! `L- br•
No. 11033
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number
Legal Description
Project Description SEWER HOOKUP
Sq. Ft. No. No. Dw.
Size Stories - Units
New ❑ Add ❑ Alter ❑ Repair ❑ -Demolition ❑
ss V.,7 0
—�>a'
_
Minimum Setback
S1GNATURELJ6! I' J 1 .1, / DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
Estimated Valuation
$ 1004
reason: (Sec. 7031.5,Business and Professions Code: Any city or countywhich requires a
permit to construct, after, 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
Side Street Setback from Center Line
-
PERMIT
' AMOUNT
Division 3 or'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).
❑ 1, as owner of the property, or.my employees with wages as their sole compensation, will
Plan Chk: Dep.
-
Plan Chk. Bal.
Date.-- Permit
Const.Professions
do the work, and the structure is not intended or offered for sale. (Sec. .7044, Buisness and
.Code: The Contractor's License Law does not apply to, an owner of property who .
Mich.
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.
Electrical
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.) .
Plumbing
$30.00
❑ 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 Ucense.Law
does not apply to an owner of property, who buildsorimproves thereon, and. who contracts for
S.M.l:
_
such projects with a contractors) licensed pursuant to the Contractor's License Law.)
0 1 am exempt under Sec. B: & P.C. for this reason
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
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800,.Labor Code:)
Policy No. .Company
Y3�f9�
❑ Copy is filed, with the city. ❑ Certified copy is hereby furnished.
TOTAL
• DU
WORKERS'. COMPENSATION INSURANCE .a
(This section need not be completed the permit is fof one hundred dollars I( valva on
or less.)
I certify that in the performance of th9orkNfor �hich this permit is issued, 'Knot
employyany petson in any manner so as to�becomejsubject to t Oe?Worke Compensation
Laws of Caliitoinia.
Date .17 -► ,.o O 4pe r J /!/P1 R 1i/! /
N07f�d TO tAPPLICAAT.' 1f_, 6F er inakmg W Cert ica(b Ott' @mption youPshou1d become
subject' to 'the Workers' Compensation provisions of the l bor'`, de!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 it 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 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 by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
SLAB GRADE
2ND FL. SO. FT.
BONDING
YARD SPKLR SYSTEM
POR. SO. FT. ®
MOBILEHOME SVC:
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. I SO. FT. ®
GAS (ROUGH)
DRAINAGE PIPING
WALL SO. FT.
OTHER APPJEQUIP.
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
FINAL INSP.
GARBAGE DISPOSAL
FURNACE UNIT - WALL FLOOR ' SUSPENDED
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.
SO. FT. ®c
I WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1 Vi c
SEWAGE DISPOSAL
GAR. FIREWALL
SO.FT.GAR ® V4c
HOUSE SEWER
LATHING
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 O"4*P"h-RRK
OUGH WIRING.
DUCT WORK
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, r
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
,
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION C4 I LY
CERT. OCC.
- FENCE FINAL
INSPECTOR'S SIGNATURESJINITIALS
GARDEN WALL FINAL
G.A.,Code
TOTAL
Water Service I
Cashier
CVWD- 438 (11/89)
LUAUHt:LLA.VALLEY WATER DISTRICT
SHECEIPTDETAIL
Received From:
Address: -7 15 t-Vf*�,n 'Ct-_Vo -vk �
_,Zn
Account No. (4 L✓ %C,
Service Address
CA -
0 Meter(s)
13 Service(s)
0 Backflow(s)
0 House Lateral(s)
0 Detector Check(s)
0 Meter Surcharge
Sanitation Capacity Charge
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 -
Tract -
0 Bond. Payment - A.D. --Bond
Assmt.
0 Customerl)epo`sii
E(Other G60w_0,1'
Remarks: �ki ,,a X
k
0 copy to:
Cash
Check
Money
Order
G.A.,Code
TOTAL
Water Service I
Cashier
CVWD- 438 (11/89)