14524 (PLBG)P.O. BOX 1504
Buildin;,.• 54-950 Ave. RaMirP-Z 78-495 CALLE TAMPICO
Address LA QUINTA, CALIFORNIA 92253
owner maryLou Walter
Mailing `
Address atue.
CityTel.
&a CM%nta, CA 92.253
Contractor
Alias Undergkound Const.
A.dSiieriJ3 Vista Di.
City Zip Tel.
Cathedral. Catj , GA X22 . 324-1 Ii
State Lic. C42 , 4.82 1.80 City 769
& Classif.. , Lic. #
Arch:, Engr.,-
Designer
Address Tel.
No. 14524
BUILDING: TYPE CONST: ' OCC: GRP.
R. Number
Legal Description '
Project Description
Sq. Ft. No.
Size - Stories
No. Dw.
Units.
New ❑ Add ❑ Alter ❑ = Repair ❑:' Demolition ❑
City Zip State
LICENSED CONTRACTOR'S DECLARATION
I herebyy!a-ffirm that I am licensed under provisions of Chapter 9 (commencing with Section
1000) ojrDivision 3 of tt(e Business and Professions Code, and in license is in full force and
SIGNATURE 'j DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following -•
reason: (Sec. 7031.5,Business and Professions Code: Any cify..or,county which requires a
permit to construct, after, improve, demofish,'.or repair any structure, prior to. its issuance also
. requires the applicant for 'such permit to rile 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 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 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.)
❑ 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 contractors) licensed 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's om ation Insurance, or a certified copy thereof. (Sec. 3800, Labor. Code.)
Policy No. s7.`JT i'?^rl Company -C. ,r. • -
❑ py 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 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: N, • 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. ' •
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 sof- this city to' enter the. above
mentioned property for inspection purposes. -
Signature of applicant Date
Mailing Address
City, State, Zip
Estimated Valuation
$i,400.00
I
PERMIT AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing U
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL 3
0.00
REMARKS
ZON E:
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
Issued by:
Date r—�—Pefrnit
Validated by:
0
Validation:
I I -A KI A r +nnr
CONSTRUCTION ESTIMATE
NO. ELCTRICAL FEES
NO. PLUMAINC; FEES
1ST FL. SQ. FT. @ $
2ND FL. SQ. FT. @
POR. SO. FT. @
GAR. SO. FT. @
CAR P. SQ. FT.
WALL SQ. FT. @
SQ. FT. @
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTEMN
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
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APPJEQUIP.
LAUNDRYTRAY
AIR HANDLING UNIT CFM
TEMP. POLE
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET'
COMPRESSOR HP
POLE, TEM/PERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
JAMPERES SERV ENT
SHOWER
BOILER B.T.U.
SQ. FT. @ c
BATH TUB
SQ. FT. @ c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID @ 1Ya c
SEWAGE DISPOSAL
/T�,��/� 1
SQ.Ff.GAR @ 3/ac
HOUSE SEWER
REMARKS:
GAS PIPING
PERMIT FEE
MIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE FPL.CKFEE
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
SEWE R
G G
OMETIER
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
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
/T�,��/� 1
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
t - .
_ COACHELLA VALLEY WATER DISTRICT
CASH RECEIPT DETAIL
N2 61442
Received From: r - i
Address:•
Service Address _�i`L%.- •rLS /) ��-P
- i i
T'•
G.A. Code
❑ Meter(s)
$
❑ Service(s) -
-
❑ Backflow(s)
❑ House Lateral(s)
'
❑ Detector Check(s)
❑ Meter Surcharge
I!5�Sanitation Capacity Charge _`� 5
"` J �..J _�•li i1
❑ W.S.B.F.C.
❑ Temporary Construction Meter
r
❑ Turn on Charge
❑ Uncollected Account - Name
❑ Inspection Fee- Tract - _
Fee-
❑- Plan Check Fees Water I Sewer - -
-
-
Tract-
-
❑ Bond Payment - A.D. - Bond
Assmt
a.
-
❑ Customer Deposit
❑ Other
"
$—i���1/�
.TOTAL
Remarks:
zz
❑Copy.to:
-
Water Service,/Service,/;,Cashie138(11189)
BHi_CVWD-
I - a.' .. ' - � fiFt'�Y�-wt}l"e••M 4.i' I�> 1^'i"�a��'�� 1. � �• , - ._ �'jR _
�• .r r ,. ' ? .� fir'• P. 0 1a ♦.
• �' " r. ,..�:- HAMMER PUMPING
G INC. JOB INVOICE-
. t RO. Box 244$
CATHEDRAL CITY, CALIFORNIA 92235-2448 '*' 0' I
(619) 360-7448 F:
(6 19) 321-7448''Rr ' �„r- r•I' rV'p�JI1EMS ORDER NO. D TE CROEtjtO - . •� •�3
ORDCR TAKEN BY DATE PROMiSCC, 0 A.M. 4
` e« L TO ` - .. rJ R.M. •'.
'j n 11 PHONE '
• , AOOREgg 1 t
CITY
'r �IAINIDICITI.11�
HELPEROB N
O rAY WORK
�' • - DESGRIPTICIN UX WOR \ O OONTRACT • , , '�
- ... G Eh;TRA
14
DE Sr RIPT70N OP NtATERIAI_ USED—„'�� I - - r t
RCE . AM7UNT
Gallons
Pumping Fee per 1000 al.
Dumping Fee per 1000 gal,
Out of Area Fee,'.. . ` , c` '1
Locating / Opening Fee (per hour)
` SizQ System: ;
t A SERVICE CHARGE OF $20 WILL m DUE
I _ _ • ON ALL RETURNED CHECKS. �•`
A FINANCE CHARGE OF 17z% PER MONTH, 18% PER YEAR
WILL BE CHARGED ON PAST DUE ACCOUNTS OVER 30 DAYS.
~- I HOURS ` • — •{ T,
` ' LABOR .AIVIOU T �*..
' '{• ,MECHANICS TOTAL' 1 ,
• °• — '• s -- — --� MATERIALS
HELPERS., - ,�' .TOTAL
LABOR i I:
ilil ht)y aC'rlow!edge thE-.dLB(a CLVrY
0mpt6ti00 of III( AbGV9 CIRgCY1hEd'NJrk. I TOTAL LASOR .” _•r�. 'TAX'
:!(, E :NATURE '
♦ , - ' , DATC(5 TED
+
+ TOTAL v ' C -P r [y