12341 (PLBG)P.O. BOX 1504 N o . 12,341
Building -64'-028-Juaroz 78-105 CALLE ESTADO
Address LA QUINTA, CALIFORNIA 92253
Owner Fra-rjS 'Friel
Mailing�-
BUILDING: TYPE CONST. OCC: GRP.
Address
A.P. Number
City Zip Tel.
Legal Description
Contractor Project Description Sewer Connect
Valley Plumbing
APddrg Pox 665
CityZip Tel
midi®f; CA i. 92202 346-3629
State Lic. City ;
& Classif. C-36'213088 Lic. # 101 Sq. Ft. No. No. Dw.
Arch., Engr., Size Stories Units
Designer New ❑ Add ❑ Alter ❑ Repair ❑ -Demolition ❑
Address Tel.
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
, 000) of Division 3 ofJhe Business an Pro essions Code, and my license is'in full force and
,jeffect. i F +`m
_SIGNATURE DATE
OWNER -BUILDER DECLARATION I
Estimated ValUatlOn$1t700.00
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 oricounty which requires a -
permit to construct, after, improve, demolish, or repair any structure, I prior to its issuance also AMOUNT
requires the applicant for such permit to file a signed statement that he is licensed pursuant to PERMIT
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) or
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 of 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 or offered for sale. (Sec. 7044, Buisness and COr1St
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 or sale.)
❑ 1, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing 3i • 00
struct'the,pro)ect. (Sec. 7044, Business and Professions Code: The Contractor's License Law
does; nohapply.;to,ah-owner of property who builds or improves thereon, and who contracts for .S.M.I.
suchpiojects:witha contractor(s) licensed pursuant to the Contractor's License Law.)
Grading
❑ I am exempt under Sec. B. & P.C. for this reason
Driveway Enc.
Date Y' Owner Infrastructure
WORKERS' COMPENSATION DECLARATION
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. Company
01,3- y is filed with the city. O Certified copy is hereby furnished.
TOTAL 310. UU I
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 thq 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: If, alter making this Certificate or Exemption you should become ZONE: BY:
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith Minimum Setback Distances:
comply with such provisions or this permit shall be deemed revoked.
Front Setback from Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY Side Street Setback from Center Line '` I
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 )roperty Line
Lender's Name 11
Lender's Address FINAL DATE IN TO 0
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 ((P�e�r•'mit
I agree to comply with all city and county ordinances and state laws relating to building Ole l O 1993
construction, and hereby authorize representatives -of this city to enter the above-.
mentioned property for inspection purposes. Validated by: :n�
Signature of applicant Date
Mailing Address Validation: RH
sem. t
City, State, Zip + _ i
t
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING;FEES
IST FL. SO. FT. ® $
UNITS
COLL. AREA
f�
YARD SPKLR SYSTEM
2ND FL. SO. FT.
HEATING (ROUGH)
STORAGE TANK
FORMS
MOBILEHOME SVC.
BAR SINK
POR. SO. f7. p
DUCT WORK
ROCK STORAGE
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS.
METER LOOP
HEATING (FINAL)
DRAINAGE PIPING
CAR P. SO. FT. ®
GAS (FINAL)
WALL S0. FT.
DRINKING FOUNTAIN.
SO FT ®
URINAL
ESTIMATED CONSTRUCTION VALUATION $
FINAL INSP.
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
GRADING
cu. yd.
$ plus x$
WATER SOFTENER
VENT SYSTEM ' FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FINAL INSP.
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET'
COMPRESSOR HP
POLE, TEM/PERM
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 ® 1114 c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/4c
IHOUSE 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
G
SEWER eR-eff"el7M
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
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 O� L
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
COACHELLA VALLEY WATER DISTRICT
/ CASH RECEIPT DETAIL
Received From: f 'It -L—fe,
Address: !
Account No. ,.t(s)
Service Address lel— ell
0 Meter(s)
0 Service(s)
0 Backflow(s)
0 House Lateral(s)
0 Detector Check(s)
0 Meter Surcharge
LJ
L Aanitat . Ion 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 -
EI Plan Check Fees Water Sewer -
Tract -
0 Bond Payment - A.D. --Bond
,:Assmt.
0 Customer Deposit
173 Other
Remarks:
0 COPY to:
Cash
Check
Money if
Order
G.A. Code
TOTAL
Water Service 1e 1��Cashier
CVWD-438'(11189)