9568 (PLBG)i
Building
Address 54-450 JUAREZ
Owner
414 a"..
P.O. BOX 1504 No. 9568
78-105 CALLE ESTADO
LA QUINTA; CALIFORNIA 92253
(BY REMINGTON ESCROW)
Mailing
Address v
Cityp Tel.
LA QUINTA, Cr 92253 1564-
Contractor
ECONOSEVER SERVICES
- P O BOK 192
City
PALM DESERT
Zip
92260
Tel.:
346-2793
State Lic.
& Classif. 480 96.1
City
Lic. # 342
' Arch., Engr., '
Designer
Address
Tel.
City Zip State
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 osiness anb'Professisiorfs' Code, and my license is in full force and
SIGNATURE4;-- '":Ti ' ""'ti i 1.✓ 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, 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 '
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
rdo'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
-' r'.fiuilds or improves thereon and who does such work himself or through his own employees,
f 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-bugder will have the burden
ofproving 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-
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.) '
❑ I am exempt under Sec. B. & P.C: for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self -insure, or s -certificate of
WorkerlgE pe cation I 4rany Sor a certified c�pythereof!Serti,3'800, Labor Code.)
.0 tri 1.. i ♦ T •v aauu- v.
Policy IV o. Company
❑Copy is filed with the city. 0 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 (8100) valuation
or less.)
I certify that in the performance of the 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: It, after making this certificate of Exemption you should become
subject to the Workeis' 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.)
Lender's Name
Lender's Address
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.
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
Mailing Address
City, State, Zip
LDING: TYPE CONST:SEWS g00%tYGRP.
A.P. Number
(Legal Description
Project Description
5
SEER HOOKUP
Sq. Ft.
Size
No. No. Dw.
Stories Units
New ❑ Add ❑
Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
. D Cs is
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
$30.00
S.M.L.
Grading
Driveway Enc.
Infrastructure
TOTAL
$ 3 QI . u o
REMARKS
".9t4nn 4 A 114 A trixc_4r_C)4
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
FINAL DATE INSPECTOR
Issued by: Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL SO. FT. ® $
2ND FL SO. FT.
POR. SO. FT. ®
GAR. SO. FT. ®
CARP. SO. FT.
WALL SO. FT. ®
SO FT ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
T
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN.
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
ROUGH PLUMB.
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE . DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
FOUND. REINF.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET'
COMPRESSOR HP
POLE, TEWPERM
LAVATORY
M
HEATING SYSTEFORCED 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% c
SEWAGE DISPOSAL
SO.FT.GAR ® V4c
HOUSE SEWER
GRADING
cu. yd.
plus x$
c$
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
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
$
GRADING
cu. yd.
plus x$
c$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL
ROOFING
,INNSP.
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
is
Received From:
Address:
Account No. &V Z Lots) Y
Service Address
0 Meter(s)
0 Service(s)
0 Backflow(s)
0 House Lateral(s)
0 Detector Check(s)
0 Meter Surcharge 7Z
X ss
Sanitation 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 -
0 Plan Check Fees Water / Sewer -
Tract -
0 Bond Payment - A.D. --Bond
Assmt
0 Customer Deposit
0 Other
-Remarks: _19
. , 4 M - ii i
0 COPY to:
Cash
N7
Check
Money
Order
'43790
G.A. Code
TOTAL