9537 (PLBG)44
P.O. BOX 1504 . No. 9537
Building 7&105 CALLE ESTADO
Address 49--9£80 Coat ':4'lla Dr. LA QUINTA, CALIFORNIA 92253
Owner
Mailing
BUILDING: TYPE CONST. OCC: GRP.•
Address same
A.P. Number
Legal Description
Project Description
SEWER
HOOK UP
City
La Quin'ta
Zip
92253
Tel.
Contractor
Valley Plumbing Co.
.Address
46--780 Clinton
City Indio
Zip 92261
Tel.. 347-'3629
State Lic.
City
& Classif. C3.6 273088
Lic' # 102
Sq. Ft.
No. No. Dw.
Size
Stories Units
Arch., Engr.,
Designer
New ❑ Add ❑
Alter ❑ Repair ❑ Demolition ❑
Address
Tel.
Verification sewer fees Paid by Wanda
at =4D
City
Zip
State
Lic. #
LICENSEDA CONTRACTOR'S DECLARATION
,I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7006) of Division 3 of he Buginess nd'Krofessions Code, and my license is in full force and
SIGNATURE' /P ../ DATE
% OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractors License law for the following
reason: (Sec, 7031.5,Busfness and Professions Code: Any city or county which requires a
,permit to construct, after, 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
Me 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 debars ($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. M however, the building
or Improvement is sold within one year of completion, the owner -budder wit 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 a contractor(s) licensed pursuant to the Contractor's License Law.) .
❑ I am exempt under Sec. B. 8 P.C. for this reason
Estimated Valuation
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech: '
Electrical
Plumbing
30.00
S.M.1.
Grading
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.)
PoIICY N .Company -
opy is filed with the city. ❑ Certified copy is hereby furnished.
TOTAL
30.00
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars (5100) 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
REMARKS
Af"b r� 4 Q9 In 4981k A -115,•'•-1 i (j
0 CASH I _NVIAL •IAL 1 60 " 00
Date Owner
NOTICE TO APPLICANT: tl, 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.
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear.Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY
Side Street Setback from Center Line
1 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
FINAL DATE
INSPECTOR
Lender's Address
This is a building permit when properly filled out, signed and validated, and is subject to
expiration it 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 theabove-.
mentioned property for inspection purposes.
Issued by:
Validated by:
Date Permit
Signature of applicant Date
Mailing Address
Validation:
City, State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SQ. FT. a $
UNITS
SLAB GRADE
2ND FL. SQ. FT.
BONDING
YARD SPKLR SYSTEM
POR. SQ. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
FOUND. REINF.
GAS (ROUGH)
DRAINAGE PIPING
CAR P. I SQ. FT.
OTHER APPJEQUIP.
REINF. STEEL
WALL SQ. FT.
TEMP. POLE
DRINKING FOUNTAIN.
SO. 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
REMARKS:
LAUNDRY TRAY
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.
SQ. FT. ® c
BATH TUB
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 1% c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ec
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 & AIR COND. SOLAR
SETBACK
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
�r OUGH WIRING.
DUCT WORK
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 SIGNATURES/INITIALS
-
GARDEN WALL FINAL