14381 (PLBG)cu
A.! r ..
P.O. BOX 1504 N o . 14381.
Auildin '52-560 Ave. alejo 78 495 CALLE TAMPICO
-� LA QUINTA, CALIFORNIA 92253 �!
Owner �,^`veris8 Sa13
Mailing ,. BUILDING: TYPE CONST. OCC: GRP,
Address S=1e
A.P. Number
City Zip Tel.
Zaa Quint i .A . _92253. 564-.089.4 Legal Description
ContractorProject Description Se er Connect
Address .
City Zip Tel.:
State Lic. City
& Classif... Lic. # Sq. Ft. No. No. Dw.
Size - Stogies' " • . . Units
'Arch., Engr.;
'Designer' New ❑ Add ❑ Alter ❑; Repair .-Demolition ❑ .
Address Tel. v
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION -
I hereby affirm that) 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' Estimated Valuation ; '000.00 '
I hereby affirm that 1 am exempt from the Contractor's License Law for the following •'
. reason: (Sec. 7031.5,Bustness' and Professions Code: Any -city or county which requires •a
permit to construct, after, Improve, demollsh, . or repair any -structure, . prior to -its issuance also
iequires the applicant for such permit to rite a signed statement -that he is 41censed. pursuant to. PERMIT' - - „ *• AMOUNT _
-_the, provisions of the Contractor's License Law, Chapter 9 .(commencing with Section 7000) of - -
Division 3 o/ 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 Plan Chk.. Dep. - -
Kubjects the applicant to a c/vil 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.
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.oHered for 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 bulld or irnprove for the purpose of sale.)
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con- .Plumbing 30i,00 _ T
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 .
•
0-1amexempt under Sec. - )r - rB. & P.C. for this reason
Driveway Enc.
Dateowner Infrastructure
WORKERS' COMPENSATION DECLARATION
I hereby affirm that l have a certificate of consent to self -insure, or a certificate of r
Worker's Compensation Insurance, or a certified copy thereof.'(Sec. 3800, Labor Code.)
Policy No. Company
❑ Copy is filed with the city. O Certified copy is hereby furnished...
TOTAL 30.00.
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 thq work for which this permit is issued; I shall not
employ any pperson in any manner so as. to become subject to°the Workers' Compensation'
" ate7f 'aws !Awner`,
RID 82E TO APPLICANT., N, after making this Certificate of Exemption you • should • become
sub/act to the Workers' -Compensation provisions - of the Labor Code, you mustforthwith
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.
• Ttiis 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
REMARKS
ZONE:'
BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop: Line'
'Side Street Setback from Center Line
Side Setback from Property_Line
FINAL DATE
INSPECTOR
Issued by:
Date it
Validated by:
Validation:
R
6�V.
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBIW FEES
1ST FL. SO. FT. ® $
UNITS
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
YARD SPKLR SYSTEM
2ND FL. SQ. FT.
HEATING (ROUGH)
STORAGE TANK
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
DUCT WORK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
METER LOOP
DRAINAGE PIPING
CAR P. SQ. FT.
OTHER APPJEQUIP.
REINF. STEEL
WALL SQ. FT.
TEMP. POLE
DRINKING FOUNTAIN
SQ. FT. ®
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER HEATER
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
BOND BEAM
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
=$
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
FINAL INSP.
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/. c
SEWAGE DISPOSAL
SPARK ARRESTOR
SQ.FT.GAR ® 3/ac
HOUSE SEWER
GAR. FIREWALL
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
IMECH.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 OR SEPTIG TANK
ROUGH WIRING
DUCT WORK
ROCKSTORAGE
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
f
1-21-71F141
F%
A
M
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURcSIINITIALS
GARDEN WALL FINAL 77d
COACHELLA VALLEY WATER DISTRICT
CASH RECEIPT DETAIL
K! It
Received From: A L-' i t Lf— �, I \
_ Date
Address: �r-�t —.`� l •�? <}Y ec rt (�yrt i ��' .'t /(l l=' ��
Account No.6 C: f_, / I / J Lot(s) I it I! / <a - J .Cr
i Tract
Service Address G.A. Code
O . Materia) $
❑ Service(s)
O Backflows)
❑ House Lateralis)
O DetectorCheck(s)
O Meter Surcharge r
0 -Sanitation Capacity Charge
❑ W.S.B.F.C.
O Temporary Construction Meter
❑ Turn on Charge
❑ Uncollected Account - Name
❑ Inspection Fee - Tract -
Fee -
O Plan Check Fees Water I Sewer -
Tract -
❑ Bond Payment- A.D.- Bond
❑ Customer Deposit
O Other
. TOTAL $
Remarks: L i f (•'%ri r!
1 /p 4 �7 l
OCopy to:
Cash
r,
Water Service 'r
Cashier
CVWD-438(11189)
Money