10709 (PLBG)Building 77-6613 Chihuahua
Address
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
Arte,mio Del Toro
Mailing
Address same
LaQ�aiiaa
IP 92253 Te1:
Contractor
Owner/Builder
Address..
State Lic.I City
& Classif. Lic. #
Arch., Engr.,
Designer
Address Tel.
City Zip State
- I Lic. #
LICENSED CONTRACTOR'S DECLARATION.
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of the Business and Professions Code, and my license is in full force and
effect.
SIGNATURE DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractors 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 We 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 bast
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).
,qtl, as owner of the property, or my employees with wages as their sole compensation, will
4'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 co"Wedon, 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 Coder The Contractor's License Law
does not apply to an owner of property -wfmo builds or improves thereon, and who contracts for
such projects with a contractors) licensed pursuant to the Contractor's License Law.) ,
O.1 am exempt under Sec. R. & P.C. for this reason
Date Owner /l��Gt. l rYtJ
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 tnpgwork for which this permit is issued, I shall not
employ any person in any manner soo become subject to the Workers' Compensation
Laws of California �ppT�
Data. Owner
NOTICE TO APPLICANT:V.—lafter 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.
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.)
No. 10709
BUILDING: TYPE CONST.. OCC: GRP.
A.P. Number
Legal Description
Project Description
Sewer Hook Up
Sq. Ft. No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ 'Demolition ❑
Estimated Valuation
1j200
PERMIT AMOUNT
Plan.Chk. Dep.
Plan Chk. Bal.
Const.:
Mech'k
Electrical
Plumbing 3 • UU
S.M.I.
Grading
Driveway Enc.
Infrastructure
s0 —921£•1fn
TOTAL
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
Lender's Name
Lender's Address FINAL DATE INSPECTOR
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
Issued by: Date Permit
construction, and hereby authorize representatives -of this city to enter the above-.
mentioned property for inspection purposes. Validated by:
Signature of applicant Date
Mailing Address Validation:
City, State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
SLAB GRADE
2ND FL. SO. FT.
BONDING
YARD SPKLR SYSTEM
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. I SO. FT.
GAS (ROUGH)
DRAINAGE PIPING
WALL SO. FT.
OTHER APPJEOUIP.
DRINKING FOUNTAIN
SO FT ®
TEMP. POLE
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GROUT
WATER PIPING
NOTE: Not to be used as property tax valuation.
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SYSTEM
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FINAL INSP.
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.
SO. FT. ® c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1 Vi c
SEWAGE DISPOSAL
GAR. FIREWALL
SO.FT.GAR ® 3/ic
HOUSE SEWER
LATHING
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 06iMtN
OUGH 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
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION A? U
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL
From:
COACHELLA VALLEY WATER DISTRICT
CASH RECEIPT DETAIL
""—Date:
SReceived
3 7 F Ft 8
3or". -_LLA
Address: j '12
P1, I A C A
/Z 7 —7L-1
Account No. -
. Lot(.) 14'
q:;
Tract �
ELL
Service Address 77-Ej
(::,F. ct-uHuZ:HtjA
C C;-
G.A. Code
0 Meter(s)
$
0 Service(s)
0 Backflow(s)
0 House Lateral(s)
0 Detector Check(s)
0 Meter Surcharge
C1,95-nitation Capacity Charge
0 W.S.B.F.C.
0 Temporary Construction Meter
0 Turn on Charge
0 Uncollected Account -Name
• Inspection Fee - Tract -
Fee -
• Plan Check Fees Water / Sewer -
Tract -
0 Bond Payment - A.D. --Bond
Assmt.
0 Customer Deposit
0 Other
TOTAL
$ 2
Remarks:
El COPY to:
Cash
Check
Money
Order
Water Service
Cashier—
CVWD-438 (11189)