13645 (PLBG)• J
4�`�3� Ave. Velasco 78-105
BOX 1504 No. 13645
Building 78-105 CALLE ESTADO
Address LA QUINTA, CALIFORNIA 92253
Owner Bogia os
Mailing Sae
Address
citZa Quinta, CA Z'p a253 Tel. 564-1788
Cour ncer/ Bui .der
Address
State Lic. I City
& Classif. Lic. #
Arch., Engr.,-
Designer
Address Tel.
CityI Zip I State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
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
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 or the Business and Professions Code, or thathe 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 five hundred dollars ($500).
d�Fas owner of the property, or my employees with wages as their sole compensation, will
4the 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.)
❑ 1, asowner 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.)
O 1 am exempt under Sec. + f B. & P.C. for th s reason
tai Vii'" It 1 i
Date a` <3 - 3 Owner "\- � t t�
...:
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.)
Policy No. .Company
0 Copy is filed with the city. O Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
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 thg 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 A 1 Owner, A r'v
NOTICE lTO APPLICANT: ,lf, after making Vthfs SCerfifrcate or Exemption you should become
sGbjectl to the i Workers'. Compensation• provisions i of t the Labor Code, you must forthwith
�comply�wit }sure `gyp` v)ssiontsor,this peimft'shaf'be deemed revoked.
;j
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 stale 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
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number
Legal Description
Project Description SeyeiS Conn t.
Sq. Ft. No. No. Dw.
Size - Stories - Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation $10000.00
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
ZONE: BY:
Minimum Setback Distances: ;
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Cen��tjjr
Side Setback from Properiye
FINAL DATE INSPECTOR/
Issued by: Date o_! `Permif
99 MY t
Validated by:
Validation:
V
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
COLL. AREA
`
YARD SPKLR SYSTEM
2ND FL. SQ. FT.
HEATING (ROUGH)
STORAGE TANK
FORMS
MOBIL EHOME SVC.
BAR SINK
POR. SD. FT. ®
DUCT WORK
ROCK STORAGE
GAR. SO. FT. ®
POWER OUTLET
I ROOF DRAINS
METER LOOP
HEATING (FINAL)
DRAINAGE PIPING
CAR P. SQ. FT.
GAS (FINAL)
WALL SQ. FT. ®
DRINKING FOUNTAIN,
GROUT
URINAL
SQ FT ®
FINAL INSP.
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to -be used as property tax valuation
GRADING
cu. yd.
$ plus x$
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
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,TEMIPERM
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.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ac
HOUSE SEWER
MESH
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
M=CH.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
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
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
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESiINIT1ALS
GARDEN WALL FINAL
COACHELLA VALLEY WATER DISTRICT
CASH RECEIPT DETAIL
f-
t .
M4.401
Received From: T 1 ' �` ci v 1� wale:
Address: �-- �, �1(r n i <� V G S C. ri U l 1 Y
Account No. �v� ` �) Lot(s) =� 7u`� 2 �i L Tract
Service Address 4 �t'��-� �P �C�( .j. G.A. Code
a
❑ Meter(s) $
❑ Service(s)
❑ Backflow(s)
❑ House Lateral(s)
❑ DetectorCheck(s)
❑ Meter Surcharge _
Fnitation Capacity Charge SS g
' ❑ W.S.B.F.C.
❑ Temporary Construction Meter
❑ Turn on Charge
❑ Uncollected Account - Name
❑ Inspection Fee - Tract -
Fee -
❑ Plan Check Fees Water I Sewer -
t
Tract -
❑ Bond Payment - A.D. - Bond
x;
Assmt.
❑ Customer Deposit
t;.
❑ Other
TOTAL CJLD
st
` Remarks: �?� 1 ► -�- ...� a �. ;
❑ Copy to:
Cash
Check
Money
Order
Water Service
Cashier
CVWI) (11/W)
w ,
COACHELLA VALLEY WATER DISTRICT
CASH RECEIPT DETAIL
f-
t .
M4.401
Received From: T 1 ' �` ci v 1� wale:
Address: �-- �, �1(r n i <� V G S C. ri U l 1 Y
Account No. �v� ` �) Lot(s) =� 7u`� 2 �i L Tract
Service Address 4 �t'��-� �P �C�( .j. G.A. Code
a
❑ Meter(s) $
❑ Service(s)
❑ Backflow(s)
❑ House Lateral(s)
❑ DetectorCheck(s)
❑ Meter Surcharge _
Fnitation Capacity Charge SS g
' ❑ W.S.B.F.C.
❑ Temporary Construction Meter
❑ Turn on Charge
❑ Uncollected Account - Name
❑ Inspection Fee - Tract -
Fee -
❑ Plan Check Fees Water I Sewer -
t
Tract -
❑ Bond Payment - A.D. - Bond
x;
Assmt.
❑ Customer Deposit
t;.
❑ Other
TOTAL CJLD
st
` Remarks: �?� 1 ► -�- ...� a �. ;
❑ Copy to:
Cash
Check
Money
Order
Water Service
Cashier
CVWI) (11/W)