10655 (PLBG)Building
Address 77-955 CALLS COLIEYTA
Owner
MINBIL INC.
Mailing
A d ess
12- 35 COBALT WAY
City Zip Tel
Contractor
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
Address
P 0 .BOX 692
City . '
ip
Tel.:
RANCHO MIRAGE9.2270
r
341-6546
State Lic.
City
& Classif. 602395 C36
Lic. # 1914
Arch., Engr.,
Designer
Address
Tel.
City
Zip
State
Lic. #
eD aruffr'inapi m licensed udder provisions of Chapter 9•(commencing with section
of iviswn 3.oY g Business a d Professio Code, and m license is in full force and
mat 1/I ,' I 1 __�..- y ��
IFWNE141B�PER-UECLARATION .
I hereby affirm that I amexemptfrom the Contractor's License Law for the following'
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a
permit to construct, atter, 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 Section 7000) or
Division 3 of the Business and Professions Code, or that. he is exempt therefrom, and the basin
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.(S500).
O 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 6nproves thereon and who does such work himself or throughhis own employees,
provided that such improvements are not intended or. offered for sale. ff. however, the budding.
or improvement is sold within one year of completion, the owner -builder wig. have the burden
of provfng that he did not build or improve for the purpose of sale.) ..
O 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 a contractor(s) licensed pursuant to the Contractor's License Law.) -
O 1 am exempt under Sec. B. 8• 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 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.
CERTIFICATE OF EXEMPTION FROM
WORKERS'COMPENSATIONINSURANCE
(chis section need not be completed if the permit is for oge'?r ndred�dotlars ($100) valuation
or less.) f l►
I certify that in the performan fpthq. work for which this pert it is issued, I s'�hall not
employ any pperson in any mannerf"so .I become .stSbject to the dcers'�Gompensation -
Laws f Califdrnia^ _f
l�Date �✓ l ' r 1 ,.
NOTICE TO APPLICANT: It, ah r ,m y g this 9�rtifrcate of Ex hipth you s%iou - "
'subject to the Workers'-Goensation provisioL'�s o/ Me 1-a r Code, you must forthwith
comply with such provisions or this permit shall be d8emed 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
No. 1.0655
WING: TYPE CONST. & OCC: GRP.
P. Number
Legal Description
Project Description SEATER HOOKUP
Sq. Ft. No. No. Dw.
Size .. Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation $2,000
PERMIT AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const. `, $30.00
Mech. "'
Electrical
Plumbing
S.M.I. "
Grading
Driveway Enc.
Infrastructure
,v;vR.-,(.tt v HJ syr ✓� rs. 30 ,,00
TOTAL
REMARKS
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:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SQ. FT. ® $
UNITS
SLAB GRADE
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL. SQ. FT.
FORMS
ER OR SEPTIC TAMC l
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. I SO. FT. ®
OTHER APPJEOUIP.
DRAINAGE PIPING
WALL SO. FT.
TEMP. POLE
DRINKING FOUNTAIN.
SQ FT ®
GROUT
URINAL
ESTIMATED CONSTRUCTION VALUATION $
FINAL INSP.
WATER PIPING
NOTE: Not to be used as property tax valuation
WATER SYSTEM
FLOOR DRAIN
MECHANICAL FEES
=$
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
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
SPARK ARRESTOR
SO. FT. ®c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1% c
SEWAGE DISPOSAL
LATHING
SO.FT.GAR ® V4c
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PLCK.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
ER OR SEPTIC TAMC l
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
�y
Lli
G�
REMARKS:
VENTILATION
FIRE ZONE ROOFING:
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION144
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIAIS
GARDEN WALL FINAL
Received F
Address:
Account N
Service Ad
❑ Meter(s)
❑ Service(s)
❑ Backflow(s)
❑ House Lateral (s)
❑ DetectorCheck(s)
❑ Meter Surcharge
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 / Sewer -
Tract -
❑ Bond Payment - A.D. - Bond
Assmt.
❑ Customer Deposit
❑ Other
COACHELLA VALLEY WATER DISTRICT
CASH RECEIPT DETAIL
NO •!%d
VVA
TOTAL $
Remarks: i - hi,
❑Copy to:
Cash
Water Service / Y
/
Check
Money r - _ Cashier
Orderi, A` CVWD-438(11/89)
Q