14359 (PLBG)J
44
P.O. BOX 1504
Building 51-64.0 Ave. Velasco 78-495 CALLE TAMPICO
Address LA OUINTA, CALIFORNIA 92253
Owner BrAd Rbc
No. 14359
BUILDING: TYPE CONST.
A.P. Number
- OCC: GRP.-
;
Mailing Same '
Address
City
Zip
Tel.
. ILS
92253
S64- 176
Legal Description `.:
Project Description
.. .
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Address ..
City
Zip
Tel.:
State Lic.
& Classif..
City
Lic. #
Sq. Ft-
Size ' " - - -• -
x
`No. •" No. Dw.
Stories '• Units
' Arch., Engr., ...
Designer ..
New ❑ Add.❑ . Alter ❑ Repair ❑ -Demolition ❑
Address
Tel.
City
Zip
State
Lic. #
LICENSED CONTRACTOR'S DECLARATION . :.
1 hereby affirm that 1 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 Contractor's License Law for the following
reason: (Sec. 7031.5,Business and .Professions Code: Anycity 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 rile a signed statement that -he is licensed pursuant 4o',
•-: the provisions of the Contractors; License Law, Chapter 9 (commencing with. Section 7000) of
• ONislon 3 -of the Business and Professions Code, or that. he is exempt. therefrom,. and the basis.-
for the alleged -exemption. Any. violation or Section 7031.5 .by -any applicant fora permit
'Sy�abh��e.c,t,,8rtlre ""applicant to a civil penalty of not more than rive Hundred dollars ($500).
1EM 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, 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.intanded or offered for sale. If, however, the building
- or Improvement is sold within one year of completion,. the owner -builder will have The burden-
of proving that he did not build or knprove for the purpose o/ sale.) -
Estimated Valuation '
'
} y'4� o ��
.: PERMIT -.
-
' - -
- AMOUNT
Plan Chk- Dep.
Plan Chk. Bal.
Const.
'
Me -ch.-
'
Electrical
-
Plumbing
❑ I; as owner of the property, am exclusively contracting with licensed contractors to corn
struct -the project. (Sec. 7044, 'Business and Professions Code: The Contractor's License Law
does not apply to an owner o/ propertywhobuilds or Improves thereon, and who.contracts for.
such projects with a contractor(s) Ucensed pursuant to the Contractor's License Law.) -
' O I am exempt under Sec. ` --B. 8 P:C-forth is reason
-' S•M-I. •
- - -
Grading
-
Driveway Enc. '
abate<� �• owner, 6/ O
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, ora certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. Company
O Copy is filed -with the city. • D Certified copy.is hereby furnished.
TOTAL
„. CERTIFICATE OF EXEMPTION FROM
- WORKERS' COMPENSATION INSURANCE
REMARKS
(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 hg work I pr which -this permit is issued; I Shall not -
employ any person in any manner so as to b came su ect1d'the Workers' Compensation -
ompensation•LawsgfCaliforn wi
Laws I Califaimi
Date
• OTICE TO APPLICANT:r ff,'aRer- makiagtthls' Certificate, or Exemption you • should become
ubject to the Workers' • Coir,pensation : provisions of the . Labor Code, you must forthwith
comply with such proylsions or this permit shall be deemed revoked.
ZONE: BY: • .
• - -
Minimum Setback DlstanCes:
Front Setback from Center Line
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND'
Rear Setback from Rear Prop• Line, '
Side Street Setback fro ter L i e
SHALL SUBJECT AN EMPLOYER TO'CRIMINAL PENALTIES AND CIVIL -FINES- UP TO ONE
�,
HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, •
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF -THE LABOR.,CODE, INTEREST, AND
ATTORNEY'S FEES.'-
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 .-
construction, and hereby authorize representatives -of this cityto enter the. above-.
mentioned property for inspection purposes.
FINAL DATE
Issued by:
Validated by:
Side Setback from ProLin
v
PEC .
D5ate y P L \
<
%A
tJT'
Signature of applicant Date
Mailing Address
Validation;+.
ku.
City, State, ZIP
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
L
IST FL. SO. FT. ® $
UNITS
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2N0 FL. SO. FT.
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
DUCT WORK
ROCK STORAGE
GAR. SO. FT. @
POWER OUTLET
ROOF DRAINS
DRAINAGE PIPING
CAR P. SO. FT. ®
REINF. STEEL
GAS (FINAL)
WALL SO. FT.
DRINKING FOUNTAIN
SO. FT. ®
URINAL
ESTIMATED CONSTRUCTION VALUATION $
SERVICE
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
LUMBER GR.
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
FRAMING
LAUNDRY TRAY
AIR HANDLING UNIT CFM
ROOFING
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
FIREPLACE
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1% c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ac
HOUSE 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
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP./EQUIP.
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
D
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
I
COACHELLA VALLEY WATER DISTRICT
CASH RECEIPT DETAIL
Received From: _
Address:
Account No. _ C• �' �' .r- /2, Lolls)
�'•
Service Address
❑ Meter(s)
❑ Service(s)
❑ Backflow(s)
❑ House Lateral(s)
❑ Detector Check(s)
❑ Meter Surcharge
Rd Sanitation Capacity Charge
❑ 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:
G.A. Code,
.t
TOTAL S
i
❑Copy to:
Cash Water Service
Check
Money _• Cashier
Order '- �VWD-43B 111/891