15201 (PLBG)P.O. BOX 1504 No. 15201
Building 78-495 CALLE TAMPICO
Address 5.-940 Ave. Ramirez LA QUINTA, CALIFORNIA 92253
Owners
.r Tyree
Mailing BUILDING: TYPE CONST. OCC: GRP.
Address .dame
A.P. Number '
CityZip Tel.
Ira. QLlinta'a, CA 92253 Legal Description
Contractor -Sewer Connect
E Ct:O Sealer Project Description
Address
P.0. Boit 192
City Zip Tela
Palm :?eserl C 92261 346-2793
State Lic. C— City
& Classif.. v 2 1 96g Lic. # 342 Sq. Ft No.. No. Dw.
Arch:, Engr.,
Size •- Stories- Units
' - � -
Designer New ❑ Add ❑ ' Alter ❑ Repair ❑ Demolition ❑
Address Tel.
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION.
I hereby affirm that I licensed under provisions of Chapter 9 (commencing with Section
7000) of Di ision 3rof the Busjness'and Professions Code, and my license is in full f rte and
e tett: '�Y�--' . ; p,
SIGNATURE 4--N . r - DATE
t OWNER -BUILDER DECLARATION
Estimated Valuation �,�- ��
I hereby affirm that I am exempt from the Contractor's License Law for the following .'
reason: (Sec.. 703.te5,Busin`ess and Professions Code: Any - city or county• • which, requires a
permit to constlUct, alter; W' rove, demolish, or repair any structure, prior to its issuance also - -
requires thefappl. I for such permit to file a signed statement that he is licensed pursuant to PERMIT- AMOUNT -
the provisions of the Cavttracfor'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. Dep.
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 Plan Chk. Bal.
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and Const.
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.lmprove for the purpose of sale.) /�
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing V •J
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.L -
such projects with a contractor(s) [tensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec Grading B. & P.C. for this reason ,
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, ora certified copy thereof. (Sec. 3800,.Labor Code.) .
Policy Na`.� Company
41;60py is filed with the city, 0 Certified copy is hereby furnished. -
TOTAL 30.00
CERTIFICATE OF EXEMPTION FROM REMARKS
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. N, after making this Certificate of Exemption you should become
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
ZONE:
BY: '
- -
comply with such provisions or this permit shall be deemed revoked. '
Minimum Setback
Distances: -
Front Setback from Center Line
Rear Setback from Rear Prop. Line
WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL, AND
Side.Street Setback from Center Line -
SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE
HUNDRED THOUSAND DOLLARS,($100,DD0), IN -ADDITION TO THE COST OF COMPENSATION,
Side Setback from Property Line
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 .
FINAL DATE
INSPECTOR
or
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:..
-. Issued by:
Date
I agree to comply with all city and county ordinances and state laws relating• to building
Q
—1
construction, and hereby authorize representatives -of this city to enter the above-.
.
mentioned property for inspection purposes.
Validated by:
r—�
1
Signature of applicant Date
I '
.Mailing Address
,Validation:
!II
If\I 1 .100C
City, State, Zip
I
i v
U fff
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBIW FEES
1ST FL. SQ. FT. ® $
2ND FL. SQ. FT.
POR SO FT. ®
GAR. SO. FT. ®
CAR P. I SO. FT.
WALL SQ. 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
COLL. AREA
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
FORMS
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
ROUGH WIRING
LAUNDRY TRAY
AIR HANDLING UNIT CFM
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.
SQ. FT. ® c
BATH TUB
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
BOND BEAM
SO.FT.GAR ® 3/ic
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 S TI
ROUGH WIRING
DUCT WORK
HEATING (FINAL)
ROCK STORAGE
OTHER APPJEOUIP.
FOUND. REINF.
GAS (ROUGH) METER LOOP
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
n
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 DISTRICT
CASH RECEIPT DETAIL
Received From: _JJ_ I t-01 (LA1171-4 Id --f
Address: < 0
-7
Account No.
Lot(s)
Service Address
0 Meter(s)
0 Service(s)
0 Backflow(s)
I] House Lateral(s)
0- Detector Check(s)
0 me ter Su.rcharge
V'Sanitation Capacity Charge
0 W.S.B.F.C.
0 Temporary Construction Meter
C2, Turn on Charge
0 Uncollected Account - Name
0 Inspection Fee - Tract -
Fee -
0 Plan Check Fees Water Sewer -
Tract -
D Bond Payment - A.D. --Bond
Assmt.
• Customer Deposit
• Other
N! -5397-5
TOTAL
Remarks: Z2�
0 COPY to:
Cash Water Servi'(.
Check V
Money �lo l � \• -
Order \
Cashier
CVWD-438111/89)
-ECONO SEWER SERVICES
P.O. Box 192
PALM DESERT. CALIFORNIA 92261
45850
PHONE. 328-7760
346-2793
°
CUSTOMER'S ORDER NO.
PHONE
_
ECM
HELPER
STARTING DATE
DATE COMPLETED
WORK ORDERED BY
TOTALAMOUNT
$
BILL TO
IN 0
ORDER AKEN BY
ADDRESS
Lin
DAY WORK
CONTRACT
CITY
❑ EXTRA
E AND LOCATION
`
"
PHONE
ut�t.rarury ur wunn:
P�lYMFNT TFRMC NET ]O nAYQ FRAM nATF OF SFRVICF
2%% PER; MONTH CHARGE AFTER 30 DAYS '
Rgone home Total amount due LJ I otal Dining to
Signature T\) or above work: or be mailed after
completion
PROOIV 258.1eBs Inc I hereby acknowledge the satisfect ry completion of work
emtan Mass 0147E of the above described work
TOTAL MATERIALS
TOTAL LABOR
_
PLEASE PAY FROM TIHS,INV0IeE
NO STATEMENT WILL BE MAILED
TAX
DATE COMPLETED
WORK ORDERED BY
TOTALAMOUNT
$
Rgone home Total amount due LJ I otal Dining to
Signature T\) or above work: or be mailed after
completion
PROOIV 258.1eBs Inc I hereby acknowledge the satisfect ry completion of work
emtan Mass 0147E of the above described work