10775 (PLBG)Building
A
Building
788323 CREETVIEW
Owner
ROBERT COX
4 P.O. BOX 1504 4�� No . 10775
Mailing •-- -- - - -- - ---. _.....
Address SAME
City Zip Tel.
LA • QUIN'TA 92253
Contractor
HAri1fER SEVER CONST.
Tel.:
321-7448
City
Lia# 1138
Tel.
State
Lic. #
CLARATION
. and my license is in full force and
structure, prior f0 its ISSUanCe a/S0
statement that hes licensed pursuant to
(commenting with $action 7000) of
1.5 DY 'any applicant for a permit
died dollars.(5500).
_
' -•
apply to an owner of property who
himself or through his own employees,
ed /or sale. h however, the building
owner -budder wig have the burden
e.)
Code: The Contractor's License Law
Contractor's License Law.)
t
s reason
-
t to self -insure, or a certificate of
N FROM
INSURANCE
one hundred dollars ($100) valuation
act to the Workers' Compensation
01 Exemption you should become
e Labor Code, you must forthwithcaked.
GENCY
agency for the performance of the
.)
this city to enter the above-.
P 0 BOX
y city or county which requires a
is exempt there/rah, and the basis
reby furnished.
1368
City z)p
CATHEDRAL CI 'Y
State Lic.
&Classif. 410275
Arch., Engr.,
Designer
Address
City Zip
. LICENSED CONTRACTOR'S DE
I hereby affirm that I am licensed under Provisions
DECLARATION
permit to construct, after, improve, demolish, or repair any
requires the applicant /or such permit to file a signed
the provisions
o/ the Contractor's License Law, Chapter 9
Division 3 0l the Business and Pro
for the alleged exemption. Any violation o/ Section 703
subjects the applicant to a civil penalty
improves
of Chapter 9 (commencing with Section
7000) of, Division 3 of the Business and Professions Code
SIGNATURE DATE
J .
- OWNER -BUILDER
I hereby affirm that I am exempt from the Contractor's License Law for the following
_ reason: (Sec. 7031. S,Business and Professions Code: An
fessions Code, or that. he
o! not more than five hun
❑ I, as owner of the property, or my employees with wages as their sole compensation, will
do the work, and the structure is not intended or offered for sale. (Sec. 7044, euisness and
Professions Code: The Contractor's License Law does not
builds or improves thereon and -who does such work h'
provided that such improvements are not intended or offer
or improvement is sold within one year of completion, the
of proving that he did not build or improve for the purpose o/sal
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-
struct•the project. (Sec. 7044, Business and Professions
does not apply to an owner o/ property who builds or
thereon, and who contracts /or
such projects with a contractor(s)/ licensed pursuant to the Cont
❑ I am exempt under Sec. B. & P.C. for thi
Date Owner
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consen
Workers Compensation Insurance, or a certified copy thereof. (Sec. 3800. Labor Code.)
Piio{�cy No: Company
py is filed with the city. ❑Certified copy is he
✓ CERTIFICATE OF EXEMPTION
WORKERS' COMPENSATION
(This section need not be completed i/ the permit is for
or less.)
I certify that in the performance of thg work for which this permit is issued, I shall not
employ any person in any manner so as to become subject
Laws of California.
Date Owner
NOTICE TO APPLICANT: Il, aftermaking making this Cert_ i/Icate
subject to the Workers' Compensation provisions o/ W
comply with such provisions or this permit shall be deemed re
CONSTRUCTION LENDING A
I hereby affirm that there is a construction lending
work for which this permit is issued. (Sec. 3097, Civil Code
Lender's Name
Lenders Address
'This is a building permit when properly
that
filled out, signed and validated, and is subject to
expiration it work thereunder is suspended for 180 days.
1 certify that I have read this application and state
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 sof
mentioned property for inspection purposes.
Signature of applicant Date
Mailing Address
City, State, Zip
A.P. Number
Legal Description
Project Description SEWER HOOKUP
Sq. Ft. No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated valuation $1,660
. PERMIT AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mach.
Electrical
Plumbing $30.00
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL S Fo.Of}.
REMARKS
.I CF _ 1,114rt 1t E; I f41_ L .:)Q
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 Propert
, Li V
y Line
FINAL DATE
INSPECTOR
Issued by: Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PL4BING FEES
1ST FL. SQ. FT. ® $
UNITS
SLAB GRADE
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL. SQ. FT.
FORMSEWER
0
GH WIRING.
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
GAS (ROUGH)
METER LOOP
GAR. SQ. FT. ®
POWER OUTLET
I ROOF DRAINS
CAR P. I SQ. FT. ®
TEMP. POLE
DRAINAGE PIPING
WALL SQ. FT.
GROUT
DRINKING FOUNTAIN.
SQ FT ®
FINAL INSP.
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER SYSTEM
WATER PIPING
NOTE: Not to be used as property tax valuation
_$
FLOOR DRAIN
MECHANICAL FEES
FRAMING
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
REMARKS:
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.
SQ. FT. ®c
BATH TUB
_
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 1+/. c
SEWAGE DISPOSAL
MESH
SQ.FT.GAR ® 3/ic
HOUSE SEWER
INSULATION/SOUND
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
FORMSEWER
0
GH WIRING.
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
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
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION -
G
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
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{3
COACHELLA VALLEY WATER DISTRICT
/� ) CASH RECEIPT DETAIL�0��
Received From: ' `o be ) ` �� 'G7� Date:
Address: -7 X31 5 l tre 5 i �� ! �.(..ti U� C f2({ I ► i i c7 C ��
Account No. �� ( Lots) "7 f
Tract
Service Address +n �n'i �A , C W G.A. Code
❑ Meter(s) $
❑ Service(s)
❑ Backflow(s)
❑ House Lateral (s)
❑ DetectorCheck(s)
❑ Meter Surcharge
Sanitation Capacity Charge }�{ -� V o
❑ W.S.B.F.C. {
❑ Temporary Construction Meter
❑ Turn on Charge
❑ Uncollected Account- Name
❑ Inspection Fee -Tract -
Fee -
❑ Plan Check Fees Water I Sewer -
Tract -
❑ Bond Payment - A.D. - Bond
❑ Customer Deposit
❑ Other
Remarks: 01 a 1!) Y) A I o f ►,
❑Copy to:
Cash }pL r�
Check t�
Money
Order
TOTAL $ 1 , 7Z- 5- t v
Water Service
•
Cashier j J
z''
CVWD-438(11189)