13610 (PLBG)' r
QUM&
�,S P.O. BOX 1504
Building 78-105 CALLE ESTADO
Address LA QUINTA, CALIFORNIA 92253
No. 13610
Owner Rosenthal & ASSOCiates
BUILDING: TYPE CONST.
A.P. Number
OCC: GRP. -
Mailing
Address 72-261 Thry 111, Ste. X37
City
ZipTel.
Palm Desert# 4A
92260.
773--0063.
Legal Description
Project Description
Sewer Connect
Contractor
Awa CeSspool : erViCep Inc.
Arae S183
A
City '1�Zip
Desert not SpmNgs
92240
Tela
329-6875
State Lic. e".2 252
& Classif.
City 3$5
Lic. #
Sq. Ft.
No. No. Dw.
Size �
Stories Units
• Arch., Engr., - � �
Designer
New ❑ Add ❑
`-
Alter ❑ Repair ❑ -Demolition ❑
Address {
City
Tel.
State
JZip
-y - -
Lic. #
L LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I amlicensed under provisions of Chapter 9 (commencing with Section
7900) of Division 3 of the Business and Professions Code, and my license is in full force and
-fact 1-7
'
SIGNATURE DATE
OWNER BUILDER DECLARATION
I a 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, 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
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
subjects the applicant to a civil penalty of not more than five hundred dollars ($500).
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 improves thereon and who does such work himself or through his own employees,
provided that such improvements are not intended or offered for sale. B, 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.)
❑ 1, 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. & P.C. for this reason
Estimated Valuation
$1on.00
f
PERMIT
-
/'� AMOUNT
plan Chk. Dep.to
Plan Chk• Bal.
.
Const.
Mech. -
Electrical
Plumbing
30.00
S. M. 1.
Grading
Driveway Enc.
Date owner
Infrastructure
# 1 WORKERS' COMPENSATION DECLARATION
i�
I hereby affirm that 1 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. r'� Company
CLCa is filed with the city. ❑ Certified copy is hereby furnished.
TOTAL
3 t) • U U
REMARKS
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 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.
S
Date Owner
NOTICE TO APPLICANT. If, 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:
Minimum Setback Distances:
BY:
'
t
Front Setback from Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of the0//,Nwork for which this permit is issued. (Sec. 3097, Civil Code.)
t
"
Side Street Setback from Gunter Line
Side Setback from Propert Line
Lender's Name
FINAL DATE
Issued by:
Validated by:
Validation:
INSPECTO�i�\•
{ r//
/ V
Date j U/ Rdknit
7
� r
Lender's Address
This is a building permit when property 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—
ateMailing Address
Mailing
City, State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SQ. FT. ® $
UNITS
SLAB GRADE
r f +
BONDING
YARD SPKLR SYSTEM
2ND FL. SQ. FT. ®
FORMS
SEWERAN
POR. SO. FT. @
MOBILEHOME SVC.
BAR SINK
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. I SQ. FT.
OTHER APPJEQUIP.
DRAINAGE PIPING
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.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
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
SPARK ARRESTOR
SQ. FT. ®c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
LATHING
SO.FT.GAR ® 3/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
SEWERAN
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REIN F. 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 (0 % �Y
c
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
COACHELLA VALLEY WATER DISTRICT
CASH RECEIPT DETAIL
Received From:
Address: _
Account No. ~ Lot(s)
:.y Service Address -
_ y1 ❑ Meter(s)
i ❑ Service(s)
❑ Backflows)
❑ House Lateral(s)
t ❑ DetectorCheck(s)
{. ❑ Meter Surcharge _
❑k" Sanitation Capacity Charge o S
F ❑ W.S.B.F.C.
❑ Temporary Construction Meter
❑ Turn on Charge
r ❑ Uncollected Account - Name
(, ❑ Inspection Fee - Tract -
Fee -
❑ Plan Check Fees Water / Sewer -
Tract -
E ❑ Bond Payment - A.D. - Bond
Assmt.
❑ Customer Deposit
❑ Other
Tract
G.A. Code
K
,CY .
1—
n /� ^ TOTAL $
{g Remarks:�1L� t.-b�
i
❑Copy to:
c Cash
Check
Money
Order
Water Service
Cashier
CVWD, 438(11/89)