13918 (PLBG)T4ht 4 4 Q9miw �.
Buildinl 5'4-.290 Ave. Velasco
Address
ownertoachella Valley Land
Address 98150 Calle Tampico .330
City Zip Tel.
La Qreiata, CA 92253 - 564-1155
Contractor
o?i!Wer/Builder•
Address
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
No.
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number
Legal Description
Project Description Sewer ConrLec't
City Zip Tela
State Lic. City
& Classif. Lic. # Sq. Ft. No. No. Dw.
Size Stories Units
Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address Tel.
City Zip State
Lic. #
LI NSED CONTRACTOR'S DECLARATION
)thereby affirm tha(,I,a?FI' en iJ under provisions of Chapter 9 (commencing with Section
7000) ofDivision-0-6ft e,Bus . and ofessions Code, and my license is in full force and
effect. _ .I_
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: Any, city or county which requires a
permit to construct, alter, 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
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Division 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 for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars ($500).
❑ I, as owner of the properly, 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 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
of proving that he did not build or improve for the purpose of sale.)
0 I, as owner of the property, am exclusively contracting with licensed contractors to con-
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
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec. B. & P.C. for this reason
' Date Owner
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.)
• P.dlicy No: •• Company
❑ Copy;is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed i/ the permit is for one hundred dollars ($100) valuation
or less.) ,_,.---',J
I.certify that in the performance of thg work`forjiich this permit is issued, I shall not
employ any person in any manner sp as'to- a subject to the Workers' Compensation
Laws of California. � � /
Dale Owner � r
-OWTICE TO APPLICA'NPT if site m` INn , this` Certificate of Exemption you should become
subject to thee-Wprkers' Co�ensation 4pi0llsions
of
the Labor Code, you must forthwith
comply with sCch provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, Civil Code.)
Lender's Name
Lender's Address
This is a building permit when properly filled out, signed and validated, and is subject to
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.
I 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.
Signature of applicant Date
Mailing Address
City, State, Zip
3timated Valuation
sltSoo.00
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
30.04
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
JU * 0
REMARKS
ZONE: BY:
Minimum Setback Distances: aF
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from°Ce er`Line
Side Setback from Property Line.A
FINAL DATE -INSPECTOR Ir.l f f
Issued by: Date �" HeIG-7 2 ion . I11 #
Validated by: Sy. vJ� AN
Validation. •R'
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
SLAB GRADE
` v
BONDING
YARD SPKLR SYSTEM
2ND FL. SO. FT.
FORMS
SEWER BAL."12F16TARIK—
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK I
POR. SO. F7. ®
GAS (ROUGH)
METER LOOP
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
GAS (FINAL)
TEMP. POLE
DRAINAGE PIPING
CAR P. SO. FT. ®
GROUT
I
WALL SO. 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
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
VENTILATION
LAUNDRYTRAY
AIR HANDLING UNIT CFM
FIRE ZONE ROOFING
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
LATHING
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/e 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 BAL."12F16TARIK—
ROUGH WIRING
DUCTWORK
ROCKSTORAGE
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.
FINAL INSP.
FRAMING
FINAL INSP.
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
Received From:.
Address:
Account No.
Service Address
COACHELLA VALLEY WATER DISTRICT
CASH RECEIPT DETAIL
W. A"A"11
❑ Meter(s) - S
❑ Service(s) _
❑ Backflow(s)
O House Lateral(s)
❑ DetectorCheck(s)
❑ Meter Surcharge _ c
x Sanitation Cdpaclty Charge e 5 DD
O WS.B.F.C.
O Temporary Construction Meter
❑ Tum on Charge ,
O Uncollected Account - Name
O Inspection Fee - Tract -
Fee -
❑ Plan Check Fees Water I Sewer -
Tract -
❑ Bond Payment - A.D. - Bond
Assmt
O CuslomerDeposit
O Other
TOTAL S ,, 2
Remarks:
OCopy to:
Water Service
Cash
Check I I
aCashier
.�':. -0.3 8 (1118 9)
Money
Order
p