13262 (PLBG)Building 52-880 Ave. Rubio
Address
Owner Brawn Gormleg
Mailing
Address ai70® Ave. Coa><desSa
City Zip Tel
Cathedral Citi 9223+8
Contractor -
R.V.S. Plumbing
A 1% Lo Ve2ardo
Palm Desert,
State Lic.
& Classif. 502396
Arch., Engr.,
Designer
Address
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
92360 341--9224
City
Lic. #
Tel.
City Zip State
j Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am. licensed urider provisions of Chapter 9 (commencing with Section
7900) of Dyvisio_n 3•of thelbusipess and Prd essiMsCiide, andurtY license is in full force and
BUILDING: TYPE CONST
A.P. Number
Legal Description
Project Description
No. 13262
OCC: GRP. j
Sewer Connect
Sq. Ft. No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
I`hereby affirm t at•1 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
Estimated Valuation
requires the applicant for such permit to rile 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 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. De .
p
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
Const.
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 not build or improve for the purpose or 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
does not apply to an owner of property who builds or improves thereon, and who contracts for
.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
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. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATIONIN6URANCE
(This section need not be completed- 1/ the permit is to no hundred dollar ! ($100) valuation
or less.) 'I 1 A � / t
1 certify that in the performance of the work,for which this pgrmd `j9saed; I shall not
employ any person in any manner soas-to-becorre subject to the Work rs' Co pensati
Laws.of California. pi .} f ) `.i f a
ate'" r f Ownei " f t i! l ;\r
INNOTICE TO APPLICANT If, after mak'' thi,s 2ertilicate `f emplion you should became
subject to the Workers' 1Compensatidn' provisions of} the L�bor-t8de, _�qu must forthwith
r comply with such provisionsor this s perrfH 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 stale 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 sof this city to enter the above-.
mentioned property for inspection purposes.
Signature of applicant Date
Mailing Address
City, State, Zip
,,WVO.00
AMOUNT
38.00
Infrastructure
TOTAL 31J. VU
REMARKS
`ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear S/e back from Rear Prop. Line
Side 21 t Se from Center Line
Side $,�'tpack rope e
FINAL DATE
Issued by:_
Validated by:
Validation:
r -
s
CONSTRUCTION ESTIMATE NO. I ELECTRICAL FEES NO. I PLUMBING FEES
1ST FL.-7-7—SQ. FT. ® $
UNITS
UNDERGROUND
fi 1� V
COLL. AREA
YARD SPKLR SYSTEM
2ND FL. SQ. FT.
BONDING
HEATING (ROUGH)
d
MOBILEHOME SVC.
BAR SINK
'POR. SQ. FT.
DUCT WORK
ROCK STORAGE
FOUND. REINF.
POWER OUTLET
ROOF DRAINS
GAR. SO. FT. ®
OTHER APPJEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
DRAINAGE PIPING
CAR P. Q. FT. ®
GROUT
WATER HEATER
WALL SQ. FT. ®
FINAL INSP.
DRINKING FOUNTAIN
BOND BEAM
WATER SYSTEM
URINAL
SQ. FT. ®
=$
LUMBER GR.
ESTIMATED CONSTRUCTION VALUATION $
FINAL INSP.
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
`
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASH ER(AUTO)(DIS H)
APPLIANCE DRYER
FIRE ZONE ROOFING
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
FIREPLACE
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
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ac
HOUSE SEWER
FINAL INSPECTION3-/5--jq
3
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE [PL!.CK.FEEE
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 l6P
'
ROUGH WIRING
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
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 INSPECTION3-/5--jq
3
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
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COACHELLA VALLEY WATER DISTRICT
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Tract -
❑ Bond Payment - A.D. - Bond t ,-
{ Assmt.
❑ :Customer Deposit
t ❑- Other t.
YoTAL $ K
�. iiemarks:
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❑Copy:to
Cash, t t .xr • r WaterServli�
Check O /i /J(�`�+a.. •1 i ♦,. a ,k <.. T,t s+•n x.� 4 �i
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