10738 (PLBG)T4ht 4 4v Q"
Building
Address 46-700 CAMEO PALMS
RICHARD LI LEVI
Mailing
Address SAME
City Zip
LA QUINTA 92253
STEPPER PLUMBING
Address.
83-210 AVE 44
City
INDIA, CA
State Lic.
& Classif. 565175
Arch., Engr.,
Designer
Address
City
1 herebyy"'.iffirm that) am
7000) oft , ivision 3,of the I
effectyi
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
2201 345-4353
City
Lic. # 11
Tel.
D State
Lic. #
),NTRACTOR'S DECLARATION
der provisions of Chapter 9 (commencing with Section
J Professions Code, and my license is in full force and
OWNER BUILDER DECLARATION
No. 10738
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number
Legal Description
Project Description R EWER HOOKUP
Sq. Ft. No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
I hereby affirm that I am exempt from the Contractor's License Law for the following
Estimated Valuation
�iQO
$1,400 1
reason: (Sec. 7031.5,Business 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 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 or the Business and Professions Code, or that. he is exempt therefrom, and the basis
Any Section 7031.5 by 'any for
plan Chk. Dep.
for the alleged exemption. violation of applicant a permit'
- subjects the applicant to a civil penalty of not more than rive hundred dollars.($500).
Plan Chk. Bal.
❑ 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
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 sale. 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.)
-_ o
O I, as owner of the property, am exclusively contracting with licensed contractors to con-
Plumbing
> �
struct the project. (Sec. 7044, Business and Professions Coder 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
_
O 1 am exempt under Sec. B. & P.C. for this reason
Driveway Enc.
Date __Owner
Infrastructure
i .
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.). l
Policy No .1 Company
/ �"Copy ✓
i
i yRlw�;2�!`W:16V
( yris filed with the city. ❑ Certified copy is hereby furnished.
Y\ HH i 1#1�~
TOTAL
�f 8
CERTIFICATE OF EXEMPTION FROM
REMARKS
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 _
Date Owner
NOTICE TO APPLICANT: ff, after making this Certificate of Exemption you should become
subjectto 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 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
ateMailing 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:
Y
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
PLUMBING FEES
IST FL. SQ. FT. ® $
UNITS
COLL. AREA
2ND FL. SQ. FT.
YARD SPKLR SYSTEM
r
POR. SQ. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. I SQ. FT. ®
DUCT WORK
DRAINAGE PIPING
WALL SQ. FT.
DRINKING FOUNTAIN.
SQ FT ®
HEATING (FINAL)
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
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
GRADING
CU. yd.
$ plus x$
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.
SQ. FT. ® c
BATH TUB
VENTILATION
SQ. FT. ® c
WATER HEATER
MAX HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
^
SQ.FT.GAR ® V4c
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 FEEPLUMB. 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 OF1 IK
,UGH 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
REMARKS:
VENTILATION
FIRE ZONE ROOFING:
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION -
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL
COACHELLA VALLEY WATER DISTRICT
CASH RECEIPT DETAIL
Received From:
Address:
Account No.Lot(s) "'*P- C
Service Address /0v C ".4
0 Meter(s)
0 Service(s)
0 Backflow(s)
0 House Lateral(s)
0 Detector Check(s)
0 Meter Surcharge
X3anitation Capacity Charge
0 W.S.B.F.C.
0 Temporary Construction Meter
0 Turn on Charge
0 Uncollected Account Name
0 Inspection Fee - Tract -
Fee -
0 Plan Check Fees Water I Sewer -
Tract -
0 Bond Payment - A.D. --Bond
Assmt.
• Customer Deposit
• Other
Tri
G.A. Code
TOTAL
t. .,: "
.... "451
Remarks:
0 COPY to:
Cash
Water Service
Check
'Ar
Money
Cashier
Order
CVWD-438((1189)