11560 (PLBG)P.O. BOX 1504 , ; N o . 11560
Building ' 78-105 CALLE ESTADO
Address 52-400 Va leio LA QUINTA, CALIFORNIA 92253 D
(%�Owner
Gordon Stewart BUILDING: TYPE CONST. OCC: GRP.
Mailing
Address P.O. Box 3092 A.P. Number
City Zip Tel.
.Palm Desert 37760 Legal Description
Contractor Project Description Sewer connect
Hammer Seer Const. Inc.
Address
P.O. Sox 2448
CityZip Tel.:
State Lic. City
&Classif. ��Z Lic.# ig Sq. Ft. No. No. Dw.
Size Stories Units
Arch., Engr.,
Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address Tel.
City Zip 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 o�f'tphe Business and Professions Code, and my license is in full force and
effect.'"'4,u.C.7SR;-�,,o4-t I ( 9 - tf!:�-
SIGNATURE A, DATE
OWNER -BUILDER DECLARATION Estimated Valuation
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 AMOUNT
requires the applicant for such permit to rile a signed statement that he is licensed pursuant to PERMIT
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 bast'
for the alleged exemption. Any violation o/ Section 7031.5 by 'any applicant for a permit . Plan Chk. Dep.
subjects the applicant to a civil penalty o/ not more than five 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.
Professions Code: The Contractor's License Law does not apply to an owner o/ 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 o/ completion, the owner -builder will have the burden Electrical
o/ proving that he did not build or improve for the purpose o/ sale.)
O I, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing
struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law
does not apply to an owner 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.)
Grading
O I am exempt under Sec. B: 8 P.C. for this reason
Driveway Enc.
Date owner Infrastructure
r
WORKERS' COMPENSATION DECLARATION
I her by affirm that I have a certificate of consent to self -insure, or a certificate of
Worker' Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy o. Company
C�Copy is filed with the city. O Certified copy is hereby furnished.
TOTAL
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 0f the work for which this permit is issued, I shall not
employ any person in any manner so a 'to become subject to the Workers' Compensation
LawsofCal ifornia. �( .'rzir+#.Cl'-' SA ^4 170 111 _CJ, #{j
Date f) r'4,e;r �• .Owner c9 - i:S3 Y� 6�-"�..+ SJ i.F1JH X ? i3 t }3i 1 Jl).4"11
NOTICE TO APPLICANT. If, after making this Certificate or 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 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 Line
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.) Side Setback from Property Line
Lender's Name
Lender's Address FINAL DATE INSPECTOR
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 an6 state that the above information is correct. Issued by: Date Permit
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. Validated by:
Signature of applicant Date
Mailing Address Validation:
City, State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SQ. FT. ® $
UNITS
r
2ND FL. SQ. FT.
YARD SPKLR SYSTEM
POR. SQ. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SQ. FT.
DUCT WORK
DRAINAGE PIPING
WALL SQ. FT.
DRINKING FOUNTAIN.
SQ. FT. ®
HEATING (FINAL)
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
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
GRADING
cu. yd.
$ plus x$
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 ® 1% C
SEWAGE DISPOSAL
FIREPLACE
SQ.FT.GAR ® 3/ac
HOUSE SEWER
SPARK ARRESTOR
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 /
l
OUGH WIRING.
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
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
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION l
CERT. OCC.
FENCE FINAL 1
INSPECTOR'S SIGNATURESJINITIALS
GARDEN WALL FINAL
COACHELLA VALLEY WATER DISTRICT
CASH RECEIPT DETAIL
Received Fro Q. —Date-
4
Address:
Account No. _ Lo s) ~ T
Service Address G.A. Code
❑ Meter(s) $
❑ Service(s)
❑ Backflow(s)
❑ House Lateral (s)
❑ Detector Check(s)
❑ Meter Surcharge
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 I Sewer -
_• Tract -
❑ Bond Payment'- A.D. - Bond
Assmt.
❑ Customer Deposit
❑ Other
TOTAL $
Remarks:
❑Copy to:
Water Service
Cash
Check
Money Cashier •``�
Order CVWD-438 (11189)