15541 (PLBG)�4
Building
Address
4
P.O. BOX 1504
78-495 CALLE TAMPICO
52-185 Ave. R&'2mirez LA QUINTA, CALIFORNIA 92253
vWllwi Gilbert )Sclrrajas
Mailing saltie
Address
CityZip
Tel.
La I ainta,
9225_
Contractor
Dateland Construction
Address
50-305 HWY 111
CityCoachella, CA
zip 92236
Te398-5544
&tClassif. C42 396698
Lemic # 31
Arch., Engr.,
Designer
Address
Tel.
City IZip I State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
000)Div'ision of he Busin.@Us)�/�and✓Prosfe�sssionls�Code, and my license is in full force and
effect. p.X_/, V._jbtraAiF' l:a�sv�gc�All lAr(-es^�•�,_
SIGNATURE ,Wa DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Busi7ess 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 We 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 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).
❑ 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
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. If, however, the building
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.)
❑ 1, 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 or property who builds or improves thereon, and who contracts for
such projects with a contractors) [rcensed 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 a certificate of consent to self -insure, or a certificate of
Worker'sCc i5ensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy 1, . Company
�jrCapy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100) 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: If, after making this Certificate or 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.
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND
SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE
HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO.THE COST OF COMPENSATION,
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND
ATTORNEY'S FEES.
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, Zip
No. 15541
BUILDING: TYPE CONST. OCC: GRP.:
P. Number .
Legal Description
Project Description Se14er Connect
Sq. Ft. No: No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
r
Estimated Valuation $2,000.00
PERMIT AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing '
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear j p. 'Line
Side Street Setback froin,Center Line
Side Setback from:P,roperty Line�c'`i /
FINAL DATE
Issued by- Date_
Validated by:
Validati
x
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBINU FEES
1ST FL. SO. FT. ® $
UNITS
SLAB GRADE
2ND FL. SO. FT.
BONDING
YARD SPKLR SYSTEM
STORAGE TANK
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
DUCT WORK
ROCK STORAGE
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
HEATING (FINAL)
OTHER APP.IEOUIP.
DRAINAGE PIPING
CAR P. SO. FT.
TEMP. POLE
WALL SO. FT.
GROUT
DRINKING FOUNTAIN.
SO. FT. ®
FINAL INSP.
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER SYSTEM
WATER PIPING
NOTE: Not to be used as property tax valuation
_$
FLOOR DRAIN
MECHANICAL FEES
FRAMING
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
REMARKS:
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
I IKITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET'
COMPRESSOR HP
POLE, TEM/PERM
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 ® 1Ya c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ac
HOUSE SEWER
INSULATION/SOUND
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
EWER R S `
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP.IEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
CU. yd.
$ plus x$
_$
LUMBER GR.
�y
p FINAL INSP.
FRAMING
FINAL INSP.vj�� r
O
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 SIGNATURES/INITIALS
GARDEN WALL FINAL
COACHELLA VALLEY WATER DISTFUCT
CAS�H RECEIPT DETAIL
54141
Received F
Date
Address: lks_,(io9
-et-t-,
44
Accountl,lo.&e t1ol-14
Lot(s)
Trac,
ServiceAddress
G.A. Code
0 Meter(s)
0 Service(s)
0 Backf!ow(s)
0 House La4ral(s)
0 Detector Check(s)
MeterSurcharge
Sanitation Capacity Charge
if)
0 W.S.B.F.C.
b Temporary Construction Meter
0 Turn on Charge
0 Uncollected Account - Islame
0 Inspection Fee - Tract -
Fee -
0 Plan Check Fees Water I Sewer -
Tract -
• Bond Payment - A.D. -'-Bond
Assmt
• CustomerDeposit
• Other
TOTAL
S
Remarks:
• COPY to:
Cash
Water
Serv�
Check
.4,
Money
Ord
Cashier
CVWD-43801189)
P. E
HAIMMER PUMPI,�rlft-` JIVINVOI
P.0 t
'WHEDRAL CITY, CALIFORNV-42-28 4&-j,.
QUANT.
OE,§CPIPTIONI.OF J4�0
(619) 360-7448
ItUpo
(619021 7 48,
AMOUNT.
ED
'�allons'
74.
Pumping Fee per 1000.gaL.
ORDEW,FA"N_',8.Yi,�,
I§EEi- C1 A.M.
P.M,'
BILL TO
Ile—
0(')
Dumping Fee per 1000 gal,
ADDRE.-'
CITY
A
HELOER
JOrX& ANr
K
DESCRIPTIOX6WORK
c -
RW-
0
V
j.
S ize S ystem:
QUANT.
OE,§CPIPTIONI.OF J4�0
PRICE
AMOUNT.
P-06
'�allons'
74.
Pumping Fee per 1000.gaL.
0(')
Dumping Fee per 1000 gal,
Out of Area Fee
h IrY.,
Locating /.Opening'Fee '�r ou.
7
V
S ize S ystem:
A) P ME
0
A SERVICE dHARGE1OF $20 WILL BE DUE
- . 6NAILLRETURNED' CHECKS.
A FINANC . E CHARG E OF'wl"/2% PER MONTH; 18% PER YEAR
WILL BE CHARGED'ON PAtT,DUE ACCOUNTS OVER -30 D S.,
HOURS
..AMOUNT
To
tTALES
KAT
MECHANICS
TOTAL
LABOR
HELPERS @
A
I herebygknowlefle the t. aetory AL LABOR
c r%
complep o of the .4 ove. dx i d WOI;�--\
TAX*
SIC44ATURb.
DATE COMPLETV
TOTAL
'3 _5
Under ike �alif ornia Mechanics Lien Law any- contractor, subcontractor, J�borer, lapplier
or ot.her person who helps to improve your property, but is not paid for his/bet work or
supoiis, has a --right to.ent.6rce a claim against your property. This, means tl�at ifter a court
hearing, your property could'be sold by a court off icer -and the proceeds of the sale used to
sati , sfy thL-, , ndebt6dness. This can happen even if you have paid your contrdctor in full if the
subcontract.ors, laborers or suppliers remain unpaid.
To preserve their right to file'a.claim or lien against your property, certain claimants such
as subcontractors or material suppliers are required to provide yoki with a document entitled
"Prel,iminary Notice." Original (or prime) contractors and laborers for wages do not have to
provIde this notice. A Preliminary Notice is not a lien against your propefti. Its PuroQsd is to
notity, you of rersons who may hAve-a right to file a lien against your property if they are riot
paid. Generally, the maximum time allowed for filing a claim or lien against your property is
ninety (90) Dhvr after c6rnpletion-of your project,
TO IN -SURE EXTRA PROTECTION FOR YOURSELF AND YOUR PROPERTY,
YOU MAY WI$H TO TAKE ONE OR MORE OF THE FOLLOWING STEPS:
1) Require that payments be made directly to subcontractors and material suppliers through
_a ji�nt..control. Any"joint control a . greement-should4riclude the addendum approved by the
FtodigirAr of contractors.
2) Issue joint checks for payment, made ou�-,'tq both your contractor -and subcontractors or
material suppliers involved in the project. This'vvill help to insure that all persons due payment
are actually paid.
3) After UP.()N.making paynient on any completed phase of the project, and before making
any farther payments, require e
your contractor to provid you with unconditional lien releases
signed by each material supplier, subcontractor and taborer involved in that portion -4Ti6w--
work for which payment was -,made. on. projects'Involving improvements to a single family
residence or 'a duplex. owned by individuals, the persons signing. these. releases lose the right
to file a'claim against your property.1notheiltypes of construction this protection may still be
important,. but may not be as complete. TO PROTECT YOUF ' I$ELF UNDER:THIS 'OPTION YOU
.MUST SECERTAIN THAT ALL MATERIAL SUPPLIERt,-A 6��' '
).4ZONTRAPTORS OR,LABORERS.
HAVE SIGNED.'
7.