11700 (PLBG)Building
Address 53•'`855NelasCe7
Owner
Joyce Moberly
Mailing '
Address 53_855 Velasco
City - Zip
.
La Qu nta,, CA. 92253'
Contractor
HS'Y'.dric'scson Construction
'Address
68315 Mely Road
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
Tel.
554-7041
No. 111U0
BUILDING: TYPE CONST. OCC:.GRP.
A.P. Number
Legal Description
Project Description SE34,.'er Hookup
City.
Zip
Tel.:
Cathedral' City
92234
328--•1747
State Lic.
City
& Classif. 6541.67-.A
Lic. # 194:
Sq. Ft.
No. No. Dw.
Size
Stories- Units
Arch., Engr.;
Designer
New 0 Add. 0
Demolition O
Alter . '
•° Address
Tel.
'
City- . 7
Zip
State
Lic. #
` LICENSED CONTRACTOR'S DECLARATION -
.1 hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 the,�usi.
of ea ind�'Proferss/io(n�Code; and my license is inifull}force and
effect.
tits ` _,.. t re b" l i ,. 1'•f ! �r
. _SIGNATURE' DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
Estimated. Valuation.
rtn
$1., 2.00. 00
reason: (Sec. 7031.5,Business.and.Professlons 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
q applicant such permit to. /fie a signed statement that he !s licensed pursuant
PERMIT
_��
AMOUNT `
the provisions o/ the Contractor's License Law, Chapter •9 (commencing. with Section 7000) of
•-
'Division 3 of the Business and. Professions Code, or that. be Is- exempt therefrom, and the basis.
for the alleged exemption. Any Section 7031.5 for
Plan Chk. Dep.
violation of .by .any applicant a permit
subjects the applicant to a civil penalty o/ not more than five hundred dollars ($500). ' ' ' "•
Plan Chk. Bal..
_ ,
' O JI, 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
COnst, �. _�.'..'«•,
i
Profess Ions 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,
McCh.'
provided 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 -
of proving that he, did not build or improve /or, the purpose of sale.)
'!y ' '01, as owner of the property, am exclusively contracting with licensed contractors to con-
Plumbing
30 • 00 a ,
�rstruct the project. (Sec. 7044, Business -and Professions Code:. The Contractor's- License Law -
:does not apply toanowner o/ property -who -builds or Improves thereon, and who contracts for
S.M.I.
- - -
^' such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
f;
Grading
t'..' ❑ I. am exempt. under Sec. B. & P.C. for this reason
_+
=
Driveway Enc.
�rl !,
Date owner
Infrastructure
WORKERS' COMPENSATION DECLARATION
A 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.)
�..Policl0o. Company .
- (O Copy is filed with the city. .:O Certified copy is.hereby furnished:
i
TOTAL
' 30.00
CERTIFICATE OF EXEMPTION FROM
REMARKS -
WORKERS' COMPENSATION INSURANCE - -• -
(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 th work for which this permit is issued, I shall not
P
q �t�� '
^r• ( ' �rJ•,�,R2. A a 3T f) .'.ts4' c� Wv 1:
i z :.t x Y `Yr- a .,il Ti�(1r.
' employ any person in any manner so as to become subject to the Workers' Compensation'
Laws of California.
- - -
' 'Date_' ' Owner
NOTICE TO APPLICANT: I/, after making this Certificate o/;;Exemption you should become
ZONE:'
BY:
subject to the 'Workers' Compensation pro4isions o/ the Labor Code, you must forthwith '•
comply with such provisions or this permit shall be deemed revoked. • -
Minimum Setback Distances: ,
Front Setback from.Center. Line
Rear, Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY
Side Street Setback.from Center Linep
Ihereby affirm that there is a'construction lending agency.for-the performance of the
work for.which this permit is issued. (Sec. 3097,Civil Code.)
Side Setback from Property Line '
Lender's Name
Lender's Address
'This is a building permit when•properlyfilled out, signed and validated, and is subject to
FINAL'DATE
s
INSPECTOR a+'"
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:
- Issued by:.'
Date Permit'
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. .
r
Validated by:
Signature of applicant Date
_ Mailing Address
-,ValldatlOn:
City. State, Zip
-
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. ® $
2ND FL. SQ. FT.
POR. SO. FT. ®
GAR. SO. FT. ®
CAR P. SO. FT.
WALL SO. FT.
SO FT ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN.
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
HEATING (ROUGH)
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
DUCT WORK
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
HEATING (FINAL)
IKITCHEN 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
BOND BEAM
SO. FT. ®c
I WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11A c
SEWAGE DISPOSAL
LUMBER GR.
SQ.FT.GAR ® Wic
HOUSE SEWER
FRAMING
FINAL INSP.
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"IFF9E "C-r=l
l� ROUGH WIRING.
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
a
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
5
REMARKS:
VENTILATION
FIRE ZONE ROOFING:
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL- INSPECTION rl G
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES'INITIALS
GARDEN WALL FINAL
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' COACHELLA .YWTER 051IGT i.1k
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r,. CASH MMIPT�MAIL
Received From: j t is
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ery
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' ,p!�antlation Capacity Ciu►rpe -
Li Temp�grary Construction Meter
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F Water
• T'iact - " r
r'D Bond Payment ' A.D.
e , ,
Assmt
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TOTAL <c
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