04-5772 (PLBG)T-Vf 4 4 a"
ox 1504
CALLE TAMPICO
INTA, CALIFORNIA 92253
ber
s
Carly
Application description
Property Zoning
Application valuation
BUILDING PERMIT
BUILDING & SAFETY DEPARTMENT
(760).777-7012
FAX (760) 777-7011
INSPECTION -REQUESTS (760) 777-7153
__ 04-0:00-05772.' Date
78120 SAN TIMOTEO ST
646 -160 -024 -24 -000000 -
PLUMBING
LOW DENSITY RESIDENTIAL
3000
7/29/04
Owner Contractor
ROBERTS LENORE L PYLE-CONTRACTORS
P 0 BOX 581 PMB442 .44489 TOWN CTR WAY, D
MEDINA WA 98039 PALM DESERT CA 92260
(760) 836-0480
WCC: STATE FUND
WC: 1786344 05/10/05
CSLB: 374806 05/31/05
CCC: B
----------------------------------------------------------------------------
Permit. . . . . . . PLUMBING
Additional desc
Permit Fee 18.00 Plan Check Fee 4.50
Issue.Date . . . . Valuation . . . . 0
Qty Unit.Charge Per Extension
BASE FEE 15.00
1.00 3.0000 EA PLB WATER INST/ALT/REP 3.00
------------------------------------'----------------------------------------
Special Notes and Comments
ADDITION OF 4 INCH LINE FROM SEPTIC
SYSTEM @ REAR.OF HOUSE TO FRONT OF HOUSE
FOR FUTURE SEWER CONNECTION WHEN
AVAILABLE. WORK IS OCCURING PRIOR TO
REMODEL/ADDITION CURRENTLY IN PLAN
CHECK.
'Fee summary Charged Paid Credited Due
------------ - ---- ---------- ---------- ---------- ----------
Permit Fee Total 18.00 .00 .00 18.00
Plan Check Total 4.50 .00 .00 4.50
Grand Total 22.50 .00 .00 22.50
V
P.O. BOX 1504 •
VOICE (760) 777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number: 7 -2--:1-
Applicant:
7ZApplicant:
coN 7-4,9- r ?',\_
Applicant's Mailing Address:
Date: 7. z9- O
Architect or Engineer:
Architect or Engineer's Address:
Lic. No..
BUILDING PERMIT DECLARATIONS
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals
,Code, and my Liceer��ey� i/n rfyorce rrd eff I. _
` icense Class ) License No.__ %