10003 (PLBG)414
9 w v
C I
P.O. BOX 15041.0003
Building 78-105 CALLE ESTADO No
Address 53-300. uare2 LA QUINTA, CALIFORNIA 92253
IdOwner
J.5e3
Mailing BUILDING: TYPE CONST. OCC: GRP.
Address SAO.
A.P. Number
City Zip Tel.
La Quinta 92253 Legal Description
Contractor Project Description
Eooho Sewer Services
Address SEWER. H0011%UP
P. J. Box 192
City Zip Tel.:
Palm Desert 9226€ 346 --2793
State Lic. City
& Classif. 480961 Lic. # 342 Sq. Ft. No. No. Dw.
Arch:, Engr., Size Stories Units
Designer New ❑ Add ❑ ' Alter ❑ Repair ❑ Demolition ❑
Address Tel.
City Zip State c
LIC. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am Iicensed'undeyprovisions of Chapter 9 (commencing with Section e
l OD) of Division 3 of the Business andrProfessions Code, and my license.is in fbll force and
SIGNATURE i - i' i DATE ,
P OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following EStimated�ValUatiOn
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 file a. signed statement that he is licensed pursuant to. PERMIT - AMOUNT
the provisions o/ 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 Plan Chk. Dep.
subjects the applicant to a civil penalty o/ not more than five hundred dollars ($500).
❑ I, as owner of the property, or my employees with wages as their sole compensation, will Plan Chk. Bal.
do the work, and the structure is not intended oroffered for sale. (Sec. 7044, Buisness and Const.
Code: The Contractor's License Law does not. apply to an owner o/ 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 I, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing 30.00
struet the project. (Sec. • 7044, Business and Professions Code: The Contractor's License Law
=does not apply to an owner of property 7who builds or improves thereon, and who contracts for S.M.I.
such projects with a contractors) licensed pursuant to the Contractor's License Law.)
•
. ` 0 I am exempt under Sec. B. 8 P.C. for this reason Grading
Driveway Enc.
Date Owner Infrastructure
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. _
' TOTAL 30.00
CERTIFICATE OF EXEMPTION FROM REMARKS 1
WORKERS' COMPENSATION INSURANCE
(This section need not be completed f/ 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 parson in any manner so as to become subject to the Workers' Compensation f; ti,•s8rra .e
Laws of California. I "
Date 'Owner
NOTICE TO APPLICANT. I/, after making this Certificate of Exemption you should become ZONE: BY:
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions,or this permit Shaft be deemed revoked. Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY Side Street Setback from Center Line
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.) 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 if work thereunder is suspended for 180 days.
I certify that I have read this application and state that the above information is correct. Issued by: Date Permit
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. Validated by:
Signature of applicant Date
Mailing Address .: Validation:
City, State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBIN ad FEES
IST FL. SQ. FT. ® $
2ND FL. _ SQ. FT.
POR. SQ. FT. ®
GAR. SO. FT. ®
CARP. SQ. FT. ®,
WALL SO. FT. ®
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
BONDING
FLOOR DRAIN
MECHANICAL FEES
STORAGE TANK
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FOUND. REINF.
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
REINF. STEEL
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET'
COMPRESSOR HP
POLE,TEMIPERM
LAVATORY
i
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER. B.T.U.
SQ. FT. ® c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 1 Vi c
SEWAGE DISPOSAL s
FINAL INSP.
SQ.FT.GAR ® 3/ac
HOUSE SEWER
ROOFING
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PLCK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
a.
.i
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
ROUGH 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 h
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
/�Vw(/
/
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
'
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
COACHELLA VALLEY WATER DISTRICT
CASH RECEIPT DETAIL
Received From:
Address: 0 %�E' •
Account No.
lot )
Service Address 3 -
❑ Meter(s)
❑ Service(s)
❑ Backflow(s)
❑ House Laterals)
❑ Detector Check(s)
❑ Meter Surcharge _
Sanitation Capacity Charge 4
❑ W.S.B.F.C.
❑ Temporary Construction Meter
❑ Turn on Charge
❑ Uncollected Account - Name
❑ Inspection Fee - Tract -
Fee -
❑ Plan Check Fees Water / Sewer -
Tract -
❑ Bond Payment - A.D. - Bond
Assmt.
❑ Customer Deposit
❑ Other
Remarks:
c = '.34536
od
TOTAL
❑Copy to: J 7
i
Cash WaterServlce
Check
Money Cashier
Order CVW 1438411 189) I
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0