14583 (PLBG)' P..O. BOX 1504 No. .14583 .
Building`� 78-49.5lCALLE TAMPICO.. ,
�2-�97. AV iia VelasClb LA QUINTA, CALIFORNIA 92253
Address
Owner
1 vi. Varner ` � BUILDING: TYPE'CONST. ""'� • . • OCC: GRP.
mail no
Address 46—
City
Indio
Contractor
Zip . • IT
Number
al Description
ject Description af'9yer ' CSIT4XRaa"2fL` 'n
. c -
City Zip Tel.:
},.. State Lic. City -
V & Classif.. Lic. # Sq. Ft.`, *:'_ No. "No. Dw.
!> Size - Stories
Units.
,• Arch:, Engr:,
Designer' ' New ❑ t Add ❑ . Alter ❑ Repair El .,r Demolition ❑
'-Address Tel. '+
City Zip State 1
Lic. #
LICENSED CONTRACTOR'S DECLARATION y "
I hereby affirm that I 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 ' ... Estimated Valuation
I hereby affirm that 1 am exempt from the Contractor's License Law for the following
reason; (Sec. 7031.5,Business and Professions Code: Any city or county which- requires• a - - 1-0-0 0V
A ,
permit to construct, after, 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 •. iPERMIT - AMOUNT
-the provisions of the Contractor's License Law, Chapter 9 (commencing -with Section 7000)-o/
Division 3 of the Business and Professions Cade, 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, Buisriess and- `
Professions Code: The Contractor's License Law does not apply -to an owner of property who COr1St.•; •; .
builds or Improves thereon and who does such work himself or through his own- employees, Mech.
provlded that such improvements are not Intended or offered /or. sale. If, however, the building
or improvement is sold within one year of completion; the owner -builder will have the burden Electrical"
a� '
o/ proving that he did notbuild or improve for. the purpose o/ sale.)
,_,001 I, as owner of the property, am exclusively contracting with licensed contractors to con-. Plumbing 30.00
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 S. M. 1. - -
••:.such projects with a contractors) licensed pursuant to the. Contractor's License Law.)
❑ I am exempt under Sec. - B. 8 P.C. for this reason Grading
_ r Driveway Enc.
Date��Owne!4�419COPPOO 000040wff�ff*""�" Infrastructure
• WORKERS' COMPENSATION DECLARATION .
1 '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
O. Copy is filed with the city,. . O Certified copy is hereby furnished..
TOTAL •��
CERTIFICATE OF EXEMPTION FROM REMARKS
w`
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit Is for one hundred dollars ($100) valuation -
'orless.)' -
I certify that in the performance of thg work for which this permit is issued, 1'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: ff. after making -.this CertfticaW o/ Exemption youshouldbecome' ZONE: - BY:
subject to the Workers' Compensation. provisions o/ the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked. MII11n1Um Setback Distances: - _ • .
Front Setback from Center Line
Rear Setback from Rear Prop...Line
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND Side=Street-Setback from Center Line
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, b /A $i< Set k�from Property Line
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND' { n LLLLLLJJJ111
ATTORNEYS FEES. ' III I • I� l !1
This is a building peir iit when properly filled out; signed and validated, and.is subject to FINA' DATE ✓g INSPECTOR
expiration it work thereunder is suspended for 180.da s.•
P P Y f I i
1 � 3 995 I,
1 certify that I have read this application and state that the above information is -correct. ISSII ed.by: -� �`� � �J te• Permit
I agree to comply with all city.and county ordinances and state' laws' relating to building �1 �• �, r y
C
onstruction, and hereby authorize, representatives -of, this city•to -enter the above-. -
mentioned property for inspection purposes.. „ Vallti,�ted by��
Signature of applicant Date
Mailing.Address ' Valldatiorf' , •yr'
City, State, Zip`
�-zt
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBIW FEES
1ST FL. SO. FT. ® $
UNITS
SLAB GRADE
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL. SQ. FT. @
FORMS
SEWE R SEPT f%
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK t
POR. SQ. FT. ®
GAS (ROUGH)
e
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
GAS (FINAL)
TEMP. POLE
DRAINAGE PIPING
CAR P. SO. FT.
GROUT
WATER HEATER
WALL SQ. FT.
FINAL INSP.
DRINKING FOUNTAIN
SO. FT. ®
WATER SYSTEM
URINAL
ESTIMATED CONSTRUCTION VALUATION $
=$
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
VENTILATION
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
A - ma
LAUNDRY TRAY
AIR HANDLING UNIT CFM
s cL
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
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ac
HOUSE SEWER
FINISH GRADING
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 40
SETBACK
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWE R SEPT f%
ROUGH WIRING
DUCT WORK
ROCKSTORAGE
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.
�Q Q5
ROOFING�a
d/
�
-
REMARKS:
VENTILATION
GW6 NI'eWJG QW
A - ma
O
FIRE ZONE ROOFING
s cL
YC f
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES11NITIALS
GARDEN WALL FINAL
4l,
•
' COACHELLA VALLEY WATER DISTRICT
CASH*RECEIPT DETAIL
527.
l
Received From:
(_�2 L (,4,). VA 28 C n ��1� ��/ � Date: / •��
Address: leo' %�J �T r' o
Account No. Lot )
Service Address �' ` G.A. Code
❑ Meter(s) g
❑ Service(s)
❑ Backflow(s)
❑ House Laterals)
❑ DetectorCheck(s)
❑ Meter Surcharge
Sanitation Capacity Charge r, "S Z22, O
❑ 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
TOTAL
Remarks:
❑Copy to:
Cash Water Service
Check �r
Money J Cashier
Order CVWD-438 (Meg)
6
Mailing Address: Box 1255 PALM DESERT, CA 82261
Phone: 328-6718 / 348-6916
o Calif. State Contractors' Ucense No. 310813
Name AAl j�14L�e fenar t Bill to
Job at 2 r 7 194 1 At
City Zip City Zip
N? 6-5748
DATE w `
WORKMAN
❑ Old Customer ❑ New Customer
Classification
Telephone ( )
WORK AUTHORIZATION - I / We hereby authorize the work described along with
the necessary materials and parts
WORK ORDERED:
Time
From
To
Hours MATERIAL USED
AMOUNT
Mon.
rN4�
Tues.
Wed.
Thurs.
( C S� r
Fri.
Sat.
t AP !-✓l
Sun.
co
Total Hours
ENTERED r
Invoice
Journal
Ledger
Cards
WAIVER OF RIGHT TO CANCEL
Having initiated a contract in connection with emergency
repairs or service for the invnediate protection of persons or
real and personal property, 1 hereby state that the following
emergepgtsi; a� exist�rAeghn'gg,Jm eclat gjt�ntion:
lll000
Pursuant section 1689x.13 of the California Civil Code, I
acknowledge and hereby waive all rights to cancel the sale
within three days.
Dated Buyers Signature
TO OUR CUSTOMERS: Service men are required to have work slip signed. This is done In order to protect you, the workmen, and ourselves, and
to enable us to give you absolute satisfactory service. You are respectfully requested to examine material and labor statement before workmen
leave the job, and if you find everything satisfactory, okay this ticket. If service is unsatisfactory,. in any way, please phone our office
immediately. I find the time and'matenaf charged above satisfactory and agree to pray for same on presentation o/ Invoice, and further agree to
pay reasonable charges for collection, including attomeys fees In the event of my dehault" A PENALTY WILL BE CHARGED AT THE RATE OF
112% PER MONTH ON UNPAID BALANCES AFTER 30 DAYS OF INVOICE DATE. ANNUAL PERCENTAGE RATE 18%.
Contractors are required by law to be licensed and regulated by
the Contractors'State License Board. Anyquestions concerning a signedTrucks-Equipment
contractor may be referred to the registrar of the board whose
address is: Contractors' State License Board, 9835 Goethe Road, eY
Sacramento, CA 95827, P.O. Box 26000, Sacramento, CA 95826.
Total Material
Tax
Spice
Permits -Insurance
TOTAL
Copyright 1993 by John S. Reeves 8 Son
Reeues BUSINESS FORMS -8538 WaM810de,CukorCky,CAW=
Form 31 WAC
'727-70 i a