06780 (PLBG)4
P.O. BOX 1504 No. 06780
Building 78-105 CALLE ESTADO
Address 54-400 $Ubio LA,QUINTA, CALIFORNIA 92253
Owner
86timrie La Piaster BUILDING:.TYPE CONST. OCC: GRP. -
Mailing
Address ' t*r A.P. Number 77'x'9
City 4Zip ___JTel. "' ` � ` ` ' " ' "'
Cathedral Cf 92234 Legal Description
Contractor Project Description Smftr llo* L—up
:mer Sewer Construction
Address
CityCatbadral Gity __,321-1854
Zi
Tel.
State Lic.
City
& Classif. 410275
Lic.
L
Arch., Engr.,
Designer
Address
Tel.
p 9223�i
# So. Ft.
Size
City (Zip I
State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby( affirm that [tam licensed under provisions of Chapter 9 (commencing with Section
7008) of Division.1 t3 oof thenBusiness and'Protfe�s�sions Code, and my license its in fu_llifforce anal
effect?�aa }(< \-"`'� 1 ' L-2-_7 �vC..�.:-y rte' J t5( 0 1 R �, wf
SIGNATURE -' 1 DATE
OWNER -BUILDER DECLARATION
I hereby affign that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Buskress and Professions Code: Any city or county which requires a
permit to construct, after, improve, demolish, or repair any structure, prior to its issuance also
requires the applicant for such permit to lite a signed statement that he is licensed pursuant to
Ne provisions of the Contractors License law, Chapter 9 (commencing with Section 7000) of
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 awl penalty of not more than five hundred dollars ($500).
O 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 Contractors 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 sad within one year of completion, the owner -builder will have the burden
of proving that he did not build or enprove for the purpose of sale.)
O 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.comractor(s) licensed pursuant to the Contractor's License Law.)
O 1 am exempt under Sec B. & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
I hereby affirm that 1 have a certificate of consent to self -insure, or a certificate of
Workers Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No Company
O Copy is filed with the city- O Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed ff the permit is for one hundred dollars ($100) valuation
or less.)
I certify that in the performance of thg 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
sutyect to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this perm l 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
ame
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 100 days. '
I certiy 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
No.
Stories
No. Dw.
Units
New O Add ❑ Alter O Repair ❑ Demolition ❑
SESIEtC ?ALS To BE ABUMNED AC'C13MG TO 13.P.C.
Estimated Valuation $12700
PERMIT AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const. X15.00
Mech.
Electrical
Plumbing 15,00
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS
., Vl.+tSe:Y'+ •4 9 If r If K.
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
1
alz9ls9
Issued by:
Date Permit
Validated by:
Validation:
s .rar
alz9ls9
Issued by:
Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
2ND FL. SO. FT.
POR. SO. FT. ®
GAR. SO. FT. ®
CAR P. SO. FT.
WALL SO. FT.
SO FT .@
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
'
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN.
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
BONDING
FLOOR DRAIN
MECHANICAL FEES
FORMS
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
(ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APPJEOUIP.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
TEMP. POLE
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
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
�
SO.FT.GAR ® V4c
HOUSE SEWER
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 R SEPTI
TROUGH WIRING.
DUCT WORK
ROCK STORAGE
FOUND. REINF.
(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
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION -
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESJINITIALS
GARDEN WALL FINAL
} x} t 5rT n COACHELLA VALLtY WATER DISTRICT
CA4N Rt ctaPr DETAIL,.�' l�° .2`912
Reoelved From a. ' Date
r;Address:
}Account No _ Lot(a) c.. 'T
L ? cSsrvlcs Address' j — t F ; G.A. Cods
i Backflow(e)
' - O r Mouee LateralY(a) k
f0 DetectorCheck(s) r
0 Meter Surcharge'
� �'+ ci%sanitatlonCalmity Charge S�/ •: i .' G 1 5� (� a
`f��it40-WS.BF.0'
Temporary Constructlon Meter ^'If
'0`Tum on Charge,
" O ,uncollected Account - Name
R' 4
r Fee0,InspectionTract
;.
W�: iii
•. Fee- , . � �. � •
Ir r , f
`4 O Plan Check Fees Water I Sewer-
Y .Tract
# t3 . Bond Payment A D.
y ", • 'Asemt K I
f0 Customer Deposit''
Other
}� TOTAL
Remarks.
' f Ceah �,
`' Check r . WaterServlce' (_
Money
Order+' = r^ Cashler
CMD -43801189)