06043 (SFD)•
1
°�•� f P.O. BOX 1504 No. 06043
Building ".1 78-105 CALLE ESTADO
Address ` 54-735 Vallelo LA QUINTA, CALIFORNIA 92253
Owner
M- aadaw Land Dev►.
Mailing BUILDING: TYPE CONST. OCC: GRP.
Address Boa 921 A.P. Number 774-281-023 ►
City Zip Tel.
-Rialto 714475-600 Legal Description Lot ��
Contractor
Project Description �•�•�•
owner fit drier
Address
City Zip Tela
State Lic. City
& Classif. 361079 Lic. # 1175- Sq. Ft.No.. No. Dw.
Arch., Engr., Size Stories Units
Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address Tel.
City Zip State
Lic. #
Sever, ne septic
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) t.aof.Division 3 of the Business and Professions Code, and my license is in full force and
effec
'SIGNATURE DATE
OWNER -BUILDER DECLARATION Estimated Valuation n nrS
I hereby affirm that I am exempt from the Contractors License Law for the following 74,075.00
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 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 basis
for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit Plan Chk. Dep. 2,50.00
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 Plan Chk. Bal. 204.91
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and Const. 527.00
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, Mech. 53.50
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 "I have the burden Electrical 101.46
of proving that he did not build or Improve for the purpose of sale.)
❑ I, as owner of the property, am exclusively contracting with licensed contractors to corv. Plumbing 157.50
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 S.M.I.
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
Grading 20..00
❑ I am exempt under Sec. B. & P.C. for this reason
Driveway Enc. 20.00
Date Owner Infrastructure 1628.45
'Precise P1= 25.00
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self -insure, or a certificate of
Workers Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Cade.)
Policy No. Company
O 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.)
1 certify that in the performance of thg 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 .
Laws of California.
Date Owner
NOTICE TO APPLICANT: ft, after making this Certificate of 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
1 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
Lenders Name
Lenders 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. ' �� $g
I certify that I have read this application and state that the above information is correct. Issued by: Data 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
1ST FL. SO. FT. ® $
UNITS
I
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL SO. FT.
FORMS
91WRA Z;66GRiIC 14K
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
POWER OUTLET
ROOF DRAINS
GAR. SO. FT. ®
TEMP. POLE
GROUT
DRAINAGE PIPING
CAR P. SO. FT. ®
FINAL INSP.
BOND BEAM
WATER SYSTEM
DRINKING FOUNTAIN.
WALL SQ. FT.
=$
LUMBER GR.
FINAL INSP.��/�e
URINAL
SO. FT.
ROOFING//��y1%1;Lffi9
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
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
LAUNDRY TRAY
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.
SO. FT. ® c
BATH TUB
SO. FT. ®c
I WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
FINAL INSPECTION
SQ.FT.GAR ® 3/.c
HOUSE SEWER
CERT. OCC.
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 �'! ^^%
ROUND PLUMBI'�
UNDERGROUND
A.C. UNIT
COLL. AREA
WLLAB GRADE/
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
91WRA Z;66GRiIC 14K
ROUGH 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.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
FINAL INSP.��/�e
FRAMING /90
INS/P4.�
ROOFING//��y1%1;Lffi9
�FINAL
/��� ✓/� �//�� /���' `Ori
REMARKS:
VENTILATION
FIRE ZONE ROOFING:
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING 1 SLY1,57Q
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL
12
COACHELLA VALLEY WATER DISTRICT
1 CASH RECEIPT DETAIL
j
Received From:��i�, (o I
27?20
D o O Date: ) - y'
-)fn
Address: X :2 I� �O r /Y
� i
q�
Account No. Lot(s)
Tract
Service Address
G.A. Code
's
• it
\p Meter(s) - 3/.,
�,
—❑ Service(s) d-
' ❑ -Backflow(s) ` ", •
'' _ `yf�ur
❑ House Lateral(s)
❑ DetectorCheck(s)
❑ Meter Surcharge
--0 Sanitation Capacity Charge a '1S
❑ W.S.B.F.C.
❑ Temporary Construction Meter
j ❑ Turn on Charge
(
f
! O Uncollected Account - Name
❑ InspectionFee- Tract -
w,
Fee -
❑ Plan Check Fees Water 1 Sewer -
'f
Tract -
' ❑ Bond Payment - A.D. - Bond
! Assmt.
❑ Customer Deposit
I
❑ Other
i
Remarks:
❑Copy to:
p
TOTAL $ R Ol u ®t o
-7 V
0 f Z2.- 5.5 _ / - Water Service
v)5�Sc
Cashier
CVWD-438 (11189Y
Desert Sands Unified School District
CERTIFICATION OF PAYMENT
OF
NOTICE: THIS DOCUMENpAALftGn FEES
BE DUPLICATEDL . .
TO: City of La Quinta DATE: �q
Department of Community Development
78-105 Calle Estado1
La Quinta, CA 92253 All,�
%at
Eto certify hat (,C) rdevelwhich is
locat_ O c within
this District, has paid school facili y fees imposed pursuantto the
aut ity generat� by Gov rnment Co a Sectiolt 5308 in t @ mount of,
$ 4
covering a total of square feet of (&) residential or
( ) industrial/commercial development and that building permits for
this footage in this development may now be issued by your jurisdiction.
C� 143 6 61 17.64 c�
u -/- H3567- PtH E -9WPV&� 0, eftz22ft)
C]/ --:w 14 /b 563 for DESERT S qDS UNIF ED SCHOOL DISTRICT
White - Building Department • Yellow - Facilities Planning • Pink - Accounting • Gold - Developer
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