9967 (PLBG)PERMIT FROM CVWB ON FILF r: M CITY �
4
' 51-145 CALLS QUINTO P.O. BOX 1504 NO. 9997
Address i �rLAQUINTA,CALIFORNIA 92253
Owner
MANOUCHERR FARHADI MOAYED
Mailing
Address 5I-145 Qt3IP3T0
City Zip Tel.
LA QUINT! 92253
Contractor
JR • S .PLUMB IVIG
Address
82325 TAHQUIT2
City.Zip Tel.:
IDIO 1 92201 347=7038
& cI'as"s f811 Lic. # 1896
Arch., Engr.,
Designer
Address Tel.
Zip (State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed�u per provisions of Chapter 9 (commencing with Section
7000) of Division 3 of the Businessand Professions Code, and my license is in full force and
effect.. X.1 1-641
SLGNATIIRE .P W r.r \, ti 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 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 rite 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 or 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 penally of not more than five 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 or property who builds or improves thereon, and who contracts. for
such projects with a contractor(s) 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 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.
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 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,` '4
Date � " Owner t� J c A
'NOTICE TO APPLICANT: !f, after making thin 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.
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 certity 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
Malling Address
City, State, Zip
BUILDING: TYPE CONST
A.P. Number
OCC: GRP,:
Legal Description
Project Description SEWER HOOKUP
Sq. Ft. No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
20-9i._ __ 13
Estimated Valuation
PERMIT AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing3n
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL 3 • 010
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 Perm
Validated by:
Validati
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES •'
IST FL. SQ. FT. ® $
2ND FL. SQ. FT. ®
POR. SQ Fr. ®
GAR. SO, FT. ®
CAR P. SQ. Fr. ®
WALL SO. Fr. ®
SQ. FT. ®
ESTIMATED CONSTRUCTION VALUATION $
"'• UNITS
MOBILEHOME SVC.
POWER OUTLET
�<
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN.
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
SLAB GRADE
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
SEWER OR SEPTIC TANK d
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
DUCT WORK
LAUNDRY TRAY
AIR HANDLING UNIT CFM
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET
COMPRESSOR HP
POLE, TEM/PERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER. B.T.U.
SO. FT. ® c
BATH TUB
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. Fr. RESID ® 11/. c
SEWAGE DISPOSAL
BOND BEAM
SQ.FT.GAR ® 3l'ac
HOUSE SEWER
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 d
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 'N Ol/ L
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
L ` �� . TM r : �` Y`• p�.c� =='r � : � `T :" �' 'F•aCr y 4...: y.sTF e ^ .YtiY ;r �.: ` ;3
COACHELLA VALLEY WATER DISTRICT
CASH RECEIPT DETAIL 7 14% 97g��'� ��R F•.
Received From: f ' rz �� " Aid CA Y.Cb
/ &DzateIVOUC
Address: &0-7064,03710,-091 ��%%z � CLG! ,� /T g; (�w'.f�.-s� (2 C'A l%zu
Account No. Lots) � � Tact .P / Clue S ':•
Service Address s� — S � It U lN% 6 G.A. Cod 3
. ❑ Meter(s) $
❑ Service(s)
❑ B��ackflow(s) ``
[�i•louse Lateral(s) b �) 3 SS d
❑ Detector Check(s)
❑ Meter Surcharge
.tat Ion Capacity Charge Of
❑ W.S.B.F.C.
❑ Temporary Construction Meter '
❑ Turn on Charge
❑ Uncollected Account - Name
❑ Inspection Fee - Tract - -
Fee -
❑ Plan Check Fees Waters Sewer - n
' Tract -
❑ Bond Payment- A.D. - Bond
Assmt
❑ Customer Deposit Tf
❑ Other c
• TOTAL $
Remarks:
❑Copy to:
CashWater Service
Check
Money
Order Cashier
CVWD-438(11/89) ,
y '