15691 (PLBG)P.O. BOX 1504 No. 15691
Building 78-495 CALLE TAMPICO
Address 53-425 Avenida Velasco LA QUINTA, CALIFORNIA 92253
Owner Advanced Wall Covering
Mailing BUILDING: TYPE CONST. OCC: GRP.
Address
P*O.BOX 471A.P. Number
City Zip Tel.
Bttel tonit I934,27 Legal Description
Contractor + sewer connection
JD Mechanical Project Description
Address 74-469 Country Club Drive #D
CityZip Tel
Bermudas Dune 92201 345-7656
State Lic. City
& Classif. 51gglgg Lic. # 1162 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
I hereby affirgivthat I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Diviisifon 3 of tha[Business a(hd Professions Code, and my license is in full force and
effect. f.6' �i �w �' •,w-�'q'%•
GN TU 'bY" DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractors License Law for the following Estimated Valuation wwyy e4A nfs
reason: (Sec. 7031.5,Susiness and Professions Code: Any city or county which requires, a +?1� • 7/'.+r
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 to PERMIT AMOUNT
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of '
Division 3 or the Business and Professions Code, or thathe is exempt therefrom, and the basis ,
Plan Chk. Dep.
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 rive 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 Const.
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 enprove for the purpose of sale.)
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbin30.00
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 contractor(s) licensed pursuant to the Contractor's License Law.)
Grading
❑ 1 am exempt under Sec. B. & P.C. for this reason
Driveway Enc.
Date owner 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, or a certified copy thereof. (Sec. 3800, Labor Code.) .
Po`l' No. Company f -
I Copy Is filed with the city, 0 Certified copy is hereby furnished.
Aj� TOTAL t j '� +„ 0.00
CERTIFICATE OF EXEMPTION FROM REMARKS
WORKERS'COMPENSATIONINSURANCE 1
(This section need not be completed if the permit is for one hundred dollars ($100) valuation I,
or less.) l [
I certify that in the performance of thg work for which this permit is issued, I shall not 1A J ;
employ any person in any manner so as to become subject to the Workers' Compensation �1
Laws of California. ;
Date-Owner
NOTICE TO APPLICANT. If_ after making this Certificate of Exemption you should become ZONE: BY: �
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith -
comply with such provisions or this permit shah be deemed revoked: Minimum 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, Side Setback from Property. Line
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 FINAL DATE INSPECTOR
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 Permit
I agree to comply with all cityand 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. Validated by:
Signature of applicant Date
Mailing Address Validation:
City, State, Zip .
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBIWU FEES
IST FL. SO. FT. ® $
UNITS
SLAB GRADE
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM i
2ND FL. SO. FT. p
FORMS
SEWER S 3
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
GAS (ROUGH)
METER LOOP
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
GAS (FINAL)
TEMP. POLE
DRAINAGE PIPING
CAR P. S0. FT.
GROUT
WATER HEATER
WALL SO. FT.
FINAL INSP.
DRINKING FOUNTAIN
SO. FT. a
WATER SYSTEM
URINAL
ESTIMATED CONSTRUCTION VALUATION $
,
=$
WATER PIPING
NOTE: Not to be used as property tax valuation
FRAMING
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
-
LAUNDRY TRAY
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 ® 11/. c
SEWAGE DISPOSAL
INSULATIONISOUND
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
SETBACK
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER S 3
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.
/,l� FINAL INSP.
v t/
FRAMING
FINAL INSP. ! - �`
66f 4
ROOFING
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'�: G'.:^. :. .: ': _ ,:�_.;�_...___3�..-'+�i'c'^q?a'-'.-+^s•�7:7, 'Fn;�^ a�'!r""^,.,,.. ..n,.. %"``'.-` :�rL',..y%: _. . n.... -., .. ,... .. ''r•''
COACHELLA VALLEY WATER DISTRICT
l CASH RECEIPT DETAIL
n y�
F / / d 1/ a {'-,j .Q Wa / I (--V V -e- rc / r61 Date: O / % / % 1
Received rom.
Address: i
/
Account Nol
Service Address R 2'y�
ILo/t(s)
y a C Cid
❑ Meter(s)
❑ Service(s)
❑ Backflow(s)
❑ House Lateral(s)
❑ Detector Check (s)
❑ Meter Surcharge
Ssr
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 / Sewer -
Tract -
❑ Bond Payment - A.D. - Bond
Assmt.
❑ Customer Deposit
❑ Other
Remarks:
❑Copy to:
Cash � ;: Water Service
a4 Check;".E a .4 n
ri Moneyr,'. Cashler
Order Q, CMD -438 (11189)
!' v . . � a - .,. �![v.jl.ais:ia+1{.{`,�{"r.y w.`•�.}n+:..i:. .p`�',"r. �r , 1
'08/23/1995 15:20 6193457666'*.,. JD MECH INC
. ECONO SEWER SERVICES
P.O. Box 192
`PALM- DESERT, CALIFORNIA, 92261
PAGE 02
y
JU YyobW OWODV
461..28
1%% ►[R MONTH CHARGE AFTER 90 DAYS
signature
Onmm am 01411.
Ll NU vom sumo f Ota1 amount oue U Total pilling to
for above work: or be ffwJled after
I hataby aaknowfedps the satlsfaotwy oompfstlon comptetlon
of ft above dnsobad walk, of work
TOTAL UATeAj*AA
TOTAL LArpR
PLEASO f" ROOM *1119 !NVOWE
NO STATEMENT WILL BE MAILED
TAX
TOTALAMOUNT
OATS COMPLETED7`��llORRED
ev
signature
Onmm am 01411.
Ll NU vom sumo f Ota1 amount oue U Total pilling to
for above work: or be ffwJled after
I hataby aaknowfedps the satlsfaotwy oompfstlon comptetlon
of ft above dnsobad walk, of work