10859 (PLBG)t
P.O. BOX 1504 NQ. 10859
Building 54--.' RAMIREZ 78-105 CALLE ESTADO
Address Y LA QUINTA, CALIFORNIA 92253
Owner
OLSON
BUILDING: TYPE CONST. OCC: GRP.
Mailing
Address SAME A.P. Number
City Zip Tel.
LA QUINTA 92253 Legal Description
Contractor Project Description 1311XX SEWER HOOKUP
ECONO SEWER
Address
PALM DESERT
State Lic.
& Classif. C42-880961
Arch.; Engr.,
Designer
Address
Tel
346-2793
City
Lic. # 3.63
Tel.
City Zip State
Lic. #.
UCENSED/CONTRACTOR'S DECLARATION '
I hereby affirm tahl m licensed under provisions of Chapter 9 (commencing with Section
7000) of Division.3 o the Business and Professions Code, and my license is in full force and
effect
Sq. Ft.
Size
New ❑
Add ❑ Alter ❑ Repair ❑
\ 1\� 1r•� 6�k�•f
SIGNATURE `f 1—' �'�-•""""--"""�"�'� DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am�exempt from the Contractors License Law for the fallowing
Estimated Valuation
reason: (Sec. 703 1.5, Business andllProfessions Code: Any city or county which -requires a
'
permit to construct,alter, improve, demolish, or repair .any structure, prior to itsissuance also
requires the applicant for such permit to file a signed statement that he is licensed pursuant. to
PERMIT
the provisions or the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
NOTICE. TO APPLICANT. If, after making this Certificate of Exemption you should become
Plan Chk. Dep. -
Division. 3 of the Business and Professions Code, or that. he is exempt therefrom, and the basis.
for 'alleged Any Section 7031.5 'any for
the exemption. :violation of by applicant a permit
'subjects Me applicant to a civil penalty of not more than rive hundred dollars.($500). '
Plan Bal.
❑.I, as�owner of the property, or my employees with wages as their sole compensation, will .
.Chk.
do the -work, and the structure isnot 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
Side Street Setback from Center Line
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 of sale.) ..
work for which this permit is issued. (Sec. 3097, Civil Code.).
O 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
$.M.I.
such projects with a contractor(s) licensed pursuant to the.Contractor's License Law:)
Grading
❑ 1 am exempt under Sec. B. 8 P.C. for this reason
Driveway Enc.
Date Owner ^4a'' 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, 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:
TOTAL
CERTIFICATE OF EXEMPTION FROM REMARKS,
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars (8100) valuation
•' or less I
$600
Demolition ❑
AMOUNT
$30.00
$30.00
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 of Exemption you should become
ZONE:
BY:
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
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
CONSTRUCTION LENDING AGENCY
Side Street Setback from Center Line
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.).
Side Setback from Property Line
Lender's Name
Lender's Address
FINAL.DATE
INSPECTOR
This is a building permit when properly filled.out, signed and validated, and is subject to
expirationif 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 - Permit
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.
Validated by:
Signature of applicant Date
Mailing Address
,Validation:
City, State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING MES
1ST FL SO. FT. ® $
UNITS
SLAB GRADE
2ND FL SO. FT.
BONDING
YARD SPKLR SYSTEM
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR SO, FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SO. FT.
GAS (ROUGH)
DRAINAGE PIPING
WALL SO. FT.
OTHER APPIEOUIP.
DRINKING FOUNTAIN.
SO FT ®
TEMP. POLE
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GROUT
WATER PIPING
NOTE Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SYSTEM
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FRAMING
GARBAGE DISPOSAL
FURNACE _ UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
REMARKS:
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
MESH
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 R AIR COND. SOLAR'
SETBACK
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR WZUG T*N0
UGH WIRING.
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPIEOUIP.
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
-Received
Address:
Accountt
Service Ai
❑ Meter(s)
❑ Service(s)
❑ Backflow(s)
❑ House Lateral(s)
❑ DetectorCheck(s)
;O�M�et Surchargeation Capacity Charge
❑ W.S.B.F.C.
❑ Temporary Construction Meter
❑ Turn on Charge
❑ Uncollected Account - Name
❑ Inspection Fee - Tract -
Fee -
❑ Plan Check Fees Water / Sewer -
Tract -
❑ Bond Payment - A.D. - Bond
Assmt.
❑ Customer Deposit
❑ Other
COACHELLA, VALLEY WATER DISTRICT
CASH RECEIPT DETAIL
�831�
7
Remarks:
TOTAL $ 17 S