14440 (PLBG)4
P.O. BOX 1504
No. 14440
Building 51-835 Ave. Ramirez 78-495 CALLE TAMPICO
}Address LA QUINTA, CALIFORNIA 92253:
= Owner Coachella Valley Lana
Mailing 7$-150 '.'Calle Tampi,6o
Address
City - Zip Tel. '
La. Qui.nta,.. CA 9 33 564-5522
Contractor
Owner/Builder .
Address
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number
Legal Description
Project Description S. -m -,r v Connect
City ..
Zip
Tel.:
State Lic.
City
& Classif..
Lic. #
Sq. Ft.
No: No. Dw..
Size
Stories Units
Arch., Engr.;
- Designer
New 0. Add -O
Alter O, Repair O Demolition O
Address
Tel.
City
Zip
State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
^
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) t.of Division 3 of the Business and Professions'Code, and my license is in full force and
• effec
'
SIGNATURE - DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractors License Law for the following
reason: (Sec. 7031.5,Bustness.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 file a signed.statement that he is. licensed pursuant to.
the provisions of the Contractor's License Law, Chapter 9 (commencing with,Secton 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. d, ,however, the building'. ,
• or improvement is sold within one year of completion, the owner -builder will have the burden •
of ppving that he did not build or improve for the purpose of sale.) .
l]'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's contractors) (sensed pursuant to the Contractor's License Law.)
❑ I am exempt under Sec B. 8 P.C. for this reason
1-
ESllmated' VdlUatlOn...$1,000.00,
PERMIT-,
- -
- _ AMOUNT -
Plan Chk. Dep.
..
Plan Chk. Bal.
-
Const.
McCh.
' Electrical
Plumbing
30.00
S. M. Is
Grading
.
Driveway Enc.
Date '" towner (- "` rL-'� ••ice. �,ui .11_Q_
Infrastructure
WORKERS' COMPENSATION DECLARATION
- I hereby affirm that 'I 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 , -e!!_1!::- Company
lb-opy is. filed with the city, . ❑ Certified copy is hereby furnished.
TOTAL
3.0. U0
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
REMARKS
-
(This section need 'not be completed N 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; 1 shall not
employ any person in any manner so as to become subject*to the Workers' Compensation.,
Laws of California
.
`' • `-'
Date_L�Owner
- NOTICE TO APPLICANT: If 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.
ZONE:' - BY:
,. Minimum Setback Distances:.' -
-
Front Setback from Center Line
nWARNING:
Rear Setback from Rear Pdine
FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND.Side
SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONEHUNDREDTHOUSAND
Street Setback fromLine
DOLLARS.($100,000), IN ADDITION TO THE COST OF COMPENSATION,
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF. THE LABOR CODE, INTEREST, AND
Side Setback from Prop@
ATTORNEY'S FEES.
This is a building permit when propeRy filled out, signed and validated, and is subject to
expiration it work thereunder is suspended for 180 days.
[.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
FINAL DATE
Issued by:
Validated by:
,f/
INSMFF,CTORO
r p'
Date �` Perm1
/ o
- I , 19
Mailing Address
Validation:
City, State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBINU 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 r
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
ROUGH PLUMB.
FLOOR DRAIN
MECHANICAL FEES
HEATING (ROUGH)
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
DUCT WORK
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
GAS (ROUGH)
LAUNDRY TRAY
AIR HANDLING UNIT CFM
HEATING (FINAL)
KITCHEN 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
BOND BEAM
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1'A c
SEWAGE DISPOSAL
LUMBER GR.
SO.FT.GAR ® 3/<c
HOUSE SEWER
FRAMING
FINAL INSP.
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 OR SEPTIC TANK
-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 INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIONATURESlINITIALS
GARDEN WALL FINAL
'
COACHELLA VALLEY WATER DISTRICT
s'r i20
N
.
CASH RECEIPT DETAIL
,
2 /
Date:
eceNed From:
..1 � , � �1 / / • �i ic!.
Address: —
/—
T2o1_.,--/7
Account NO.G
Service Address -
- v
$ '
❑ Material
❑ Servlce(s)
❑ Backflow(s)
❑ House Lateral(s)
❑ Detector Check(s)
l /, (1
❑ Meter Surcharge
_
G`Sanitation Capacity Charge
❑ W.S.B.F.C.
❑ Temporary Construction Meter '
❑ Turn on Charge
❑ Uncollected Account - Name ---------
[3 Inspection Fee - Tract -
,—
Fee -
❑ Plan Check Fees Water I Sewer -
Tract -
❑ Bond Payment- A.D.- Bond__
'
Assmt.
r
❑ Customer Deposit
❑ Other
TOTAL
Remarks:
' 1 i
❑COPY to:
Water Service ��--
Cashier
Check C`j,.C� CVWD-47a1111a9)
Money
Order