12991 (PLBG)• N
- I \
P.O. BOX 1504 No 299
Building 78-105 CALLE ESTADO
Address 52-611 Bermudas LA QUINTA, CALIFORNIA 92253
Owner
i Roadrunner Escrow
' Mailing BUILDING: TYPE CONST. OCC: GRP.-
Address. 44200 Monterey Ave. A.P. Number
City, Zip Tel.
Palm Desert, :A, 92260 1 564-8470 Legal Description
Contractor "' Project Description Sewer Connect
R.V. Stevenson/RVS Plumbingy�+�C't,'-8'yx
Address
74210 Veiardo
City Zip Tela
j Palm DC 66it r ;A 92260 341--9224
State Lic. City
& Classif. X36 Sti2396 Lic. # 21313 Sq. Ft. No. No. Dw.
Size Stories Units
Arch.; Engr.;
Designer. + New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address Tel.
I r .
i City. Zip State
4 Lic. #
� LI NSEDbONTppCTOR'S DECLARATION
i I here it Ila picens uAd iovisions oTChapter 9 (commencing with Section
'} 7000) of i ' n'3 Busi ssjan r o ' C•d , and -7 H ense is i full forc
effect. �' O ��// 1 :'S +r,
SIGNATURE 1 DATE'
OWNEfTBUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following Estimated Valuation $1,000.00
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a
permit to construct, alter, improve, demolish, 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 PERMIT AMOUNT
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 Plan Chk. Dep.
subjects the applicant to a civil penalty of not more than rove 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.
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 safe. 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 improve for the purpose of sale.)
❑ I, as' owner of the property, am exclusively contracting with licensed contractors to con- Plumbing 30.00
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. 1.
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
Grading
0 1 am exempt under Sec. 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, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. Company
❑ Copy is filed with the city. ❑ Certified copy is hereby furnished.
TOTAL 30.00
CERTIFICATE OF EXEMPTION FRO/ REMARKS
WORK' COMPENATION INSURANCE
(This section need not be completed i A_frmit is for on undred dQ_V(V!,
100) valuation
or less.) f I certify that in the performa o rk for v�hie 't id, I shall not
em Io an erson 'n ab manne eco Sub' t o t ork s' m ensation
Laws dfaf
NOTICE TO6APPLICANT: fif,AffRer'm r rs rtrA JL'6xdn'don you shouk
subject to the Workers' Compensa n r fsfo o/ the Labor Code, you must
comply with such pro�rsioonns,or this pe it hal be deemed revoked.
CONSTRUCTION LENDING AGENCY
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.)
Lender's Name
Lender's Address
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
ZONE:
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 . Permit
Validated by:
Validation:
di
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SQ. FT. p $
UNITS
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
YARD SPKLR SYSTEM
2ND FL. SQ. FT.
HEATING (ROUGH)
STORAGE TANK
FORMS
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
DUCTWORK
ROCK STORAGE
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
METER LOOP
HEATING (FINAL)
DRAINAGE PIPING
CAR P. SQ. FT.
GAS (FINAL)
WALL SQ. FT.
DRINKING FOUNTAIN
SQ FT ®
WATER HEATER
URINAL
ESTIMATED CONSTRUCTION VALUATION $
FINAL INSP.
WATER PIPING
NOTE: Not to be used as property tax valuation
WATER SYSTEM
FLOOR DRAIN
MECHANICAL FEES
GRADING
cu. yd.
$ plus x$
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FINAL INSP.
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
REMARKS:
I IKITCHEN 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.
SQ. FT. ® c
BATH TUB
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 1+/a c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ac
HOUSE SEWER
GAS PIPING
PERMIT FEE
MIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE EPL.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
J
SEWER C}is['�i9'Y�AM(r�p
`I
3
UGH WIRING
DUCTWORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER 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
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
kv
H
COACHELLA VALLEY WATER DISTRICT �,
CASH RECEIPT DETAIL &Lo 4 - S l ` -7 o`i ���1 X� A a a
Received From: 0-� t.0 ) n��o•J -`'�
Address:'
Account No. (.D U(.0 1 �� �' V Lot(s)LA4,;=u Tract
Service Address ` V M l l&(A K> l�U t (� G.A. Code
❑ Meter(s)
❑ Service(s)
❑ Backflow(s)
❑ House Laterals)
❑ DetectorCheck(s)
❑ Meter Surcharge -7
P Sanitation Capacity Charge
❑ W.S.B.F.C.
❑ Temporary Construction Meter
❑ Turn on Charge
❑ Uncollected Account - Name
❑ Inspection Fee - Tract -
Fee -
❑ Plan Check Fees Water I Sewer -
Tract -
❑ Bond Payment - A.D. - Bond
Assmt.
❑ Customer Deposit j
Other Tl) LA -c6 -\L\,_ cu_�_ 1� ti L ��.i 111�U 1fd� , �TJ• i
(� TOTAL $ � -7
Remarks: �.L t�s.�y i 17��. �,L. ip 1�
❑Copy to:
Cash Water Service VsaA
Check ✓ ��1�a a
Money Cashier
Order C -438(11189)