15642 (PLBG)B�„ilding
Address
Owner
ce 4 Q”
•
P.O. BOX 1504
54-376 Ave • Velasco LA QUINTA, CALIFORNIA 92253
Gary Cotton
Mailing
Address Same
12oupitatt1 CA
Zip 92253
Tel.
Contractor
A3 Underground Const
Address
:0903 Vista Dr.
4)"ta:tAe'd a1 CitY;'pCA
92234
Tel24-.911
State Lic. , C42 482180
City 769
& Classif.
Lic. #
Arch., Engr.,
Designer
Address
Tel.
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
E I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of the Business anrd✓,Professions•.Code, and my license is in full force and
Seffect. �`Q.•r /%. >\ ' 7'`r y. / �� ?%�
IGNATURE 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: Any city 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 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 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).
❑ 1, 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 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 knprove for the purpose of sale.)
❑ 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 contractors) (leaned 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 1 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.)
Poli y o. Company
Copy is filed with the clty, . ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS'COMPENSATIONINSURANCE
(This section need not be completed N the permit is for one hundred dollars ($100) valuation
or less.)
I certify that in the performance of thip work for which this permit is issued, I 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: If, after making this Certificate of Exemption you should become
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL; AND
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 160 days.
I certify that I have read this application and state that the above information is correct.
1 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
No. 15642
BUILDING: TYPE CONST. OCC. GRP.
,A.P. Number
,Legal Description
Project Description
Sewer Connect
Sq. Ft.
Size
NO.' No. Dw.
Stories Units
New ❑ Add ❑
Alter ❑ Repair ❑
Demolition ❑
Estimated Valuation
$1,500.00
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
30.00
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
30.00
REMARKS
•-t
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line\
Rear Setback from Rear,P�dd� L/ine.
a�fmSide Street Setbr Line
Side Setback from Property, Line—'-��
FINAL DATE
Issued by: Date_
Validated
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBINU FEES
A.C. UNIT
COLL. AREA
1ST FL. SQ. FT. ® $
UNITS
BONDING
HEATING (ROUGH)
YARD SPKLR SYSTEM
2ND FL SQ. FT.
SEWER R SROUGH
WIRING
DUCT WORK
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
GAS (ROUGH)
METER LOOP
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
REINF. STEEL
GAS (FINAL)
DRAINAGE PIPING
CAR P. SQ. FT.
WALL SQ. FT.
WATER HEATER
DRINKING FOUNTAIN,
SO. FT. ®
r
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER SYSTEM
WATER PIPING
NOTE: Not to be used as property tax valuation
•
x$ _$
FLOOR DRAIN
MECHANICAL FEES
A
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
REMARKS:
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
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.
SQ. FT. ® c
BATH TUB
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
MESH
SQ.FT.GAR ® VAc
HOUSE SEWER
INSULATIONISOUND
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 R SROUGH
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.
r
_
BOND BEAM
WATER SYSTEM
,GRADING
cu. yd.
$ plus
•
x$ _$
LUMBER GR.
��ll
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 SIGNATURE311NITIALS
GARDEN WALL FINAL
Received From:_
Address: .r o5.
Account No.
(Service Address
n ue.edel
❑ Service(s)
❑ Backflow(s)
❑ House Laleral(s)
❑ Detector Check(s)
❑ Meter Surcharge
Sanitation Capacity Charge)
❑ WS.B.F.C.
❑ Temporary Construction Meter
❑ Tum on Charge
❑ Uncollected Account - Name
❑ Inspection Fee- Tract -
Fee -
❑ Plan Check Fees Water I Sewer -
Tract -
❑ Bond Payment - A.D. - Bond
Assmt.
❑ Customer Deposit
❑ Other
,At
COACHELLA VALLEY WATER DISTRICT RB Q
CASH RECEIPT DETAIL le
G.A. Code
E
TOTAL $ .
Remarks:
❑COPY to:
Check
Water Service
Money
Cashier
Order
CVWD-438 (11189)
HAMMER PUMPING INC.
P.O. Box 2448
CATHEDRAL CITY, CALIP�2235-2448
r- 11 n 1
JOB INVOICE
— I . .— CUSTOMER'S ORDER NO.
(619) 321-7448
DAil r. ORDERED
F — / (' -
ORDI It IAKI N IiY
I -All PROMISi D I I A.M.
:III H ,
r CA 0
12 �
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MI ?"F)IANIC..
Ily
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PC)
Sr
-9 we
DI::c:kII'II1)N(1I MAIIIIIAl II:;1 Ir
I-10:1
AMI)l IN
I
/,,?&CD
Gallons
I'lullping Fct! [)(!I 1000 )!.;It.
PpOv
Dumping Fee per 1000 gal. (,k
Out of Area Fee
Locating / Opening Fee (per hour)
Size System:
A SERVICE CHARGE OF $20 WILL BE DUE
ON ALL RETURNED CHECKS.
A FINANCE CHARGE OF 1'/2% PER MONTH, 18% PER YEAR
WILL BE CHARGED ON PAST DUE ACCOUNTS OVER 30 DAYS.
TOTAL
MATERIALS
111AIRS
I IWF_
MECHANICS Q
i
TOTAL
LABOR
HILLPENS
completion 01 the above de:;cribed work: TOTAL LABOR
TAX
SI :ATIJI?c'�
DATE commxrm
TOTAL
0