15862 (PLBG)s�
P.O. BOX 1504
Building 53--580 Ave Diaz 78-495 CALLE TAMPICO
Address LA QUINTA, CALIFORNIA 92253
Owner
1c Anthony Hospedeles
Mailing
Address
City Zip Tel.
Contractor
Owner Builder
------ 53500 Aire Diaz
CitLa y Zip Tel.:
Quints 92253
State Lic. City
& Classif. I Lic. #
Arch., Engr.,
Designer
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 of the Business and Professions Code, and my license is in full force and.
effect.
SIGNATURE DATE
OWNEWBUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Busiress 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 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 five hundred dollars ($500).
❑ I, 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 aro 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.)
'p I, as owner of the property, am exclusively contracting with licensed contractors to con-
struct the project. (Sec. 7044, Business andProfessions 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) #tensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec B. & P.C. for this reason
r ,
Date Owner
v�
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
O Copy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed H 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 ma r(at so as to become subject to the Workers' Compensation
Laws of California
Date Owned 4J ffit (r✓F�t '� f J
NOTICE TO APPLICANT: N, after making this j 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 ($100,100), 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 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
BUILDING: TYPE CONST
Number
No. 1,5862 '
51
OCC. GRP.
Legal Description
Project Description Se -wed' Connection /Septic Abandon
Sq. Ft.
Size
New ❑
No.
Stories
No. Dw.
Units
Add ❑ Alter ❑ Repair ❑ Demolition ❑
IEstimated Valuation $600.00
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
;30.0
Mech..
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
$30.00
REMARKS
ZONE: BY:
Minimum Setback Distances:
Front Setback from Cent F 'ne
Rear Setback from R p. ine
Side Street Setba Cente ine
Side Setback Set
roperty Un
FINAL DATE ` d \ NSPEGFPIR \1
Issued by: f J Date ` '90rmit
Validated by:
11
Validated
Validation:
1.
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBINV FEES t
1ST FL. SO. FT. ® $
UNITS
SLAB GRADE
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL. SO. FT.
FORMS
SEW R OR
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
GAS (ROUGH)
METER LOOP
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
GAS (FINAL)
TEMP. POLE
DRAINAGE PIPING
CAR P. I SO. FT. ®
GROUT
WATER HEATER
WALL SO. FT.
FINAL INSP.
DRINKING FOUNTAIN
BOND BEAM
WATER SYSTEM
URINAL
SO. FT. ®
LUMBER GR.
ESTIMATED CONSTRUCTION VALUATION $
FINAL INSP.
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
VENTILATION
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
FIRE ZONE ROOFING
LAUNDRYTRAY
AIR HANDLING UNIT CFM
FIREPLACE
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.
SO. FT. ® c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11A c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ac
HOUSE SEWER
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
SEW R OR
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP.IEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$
LUMBER GR.
/O // 9j;�
FINAL INSP.
FRAMING
FINAL INSP.-Plus-x$-=$/� // _
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL
0
o-
COACHELLA VALLEY WATER DISTRICT
r
CASH RECEIPT DETAIL
Received From: �! (`I'/ l G r•_4 /4 1(K �•i�LL:7 Date:_
Address: i-�l, E�i:ir lL). t F� ?' r� 1�� L i � (ill! (� (A
Lot(s) ;Da "!'.l- 1 ( Tract.SlAbi A CA(c Yt(-s lrA
Service Address n --5C_�F: f VEk) . D/A-7 , LA i', u ) NlmG.A. Code _T
❑ Meter(s)
O Service(s)
❑ Backtlow(s)
❑ House Lateral(s)
❑ DetectorCheck(s)
O Meter Surcharge
FYSan!tation Capacity Charge
O W.S.B.F.C.
O Temporary Construction Meter
❑ Turn on Charge
❑ Uncollected Account - Name
❑ Inspection Fee - Tract - _
Fee -
❑ Plan Check Fees Water / Sewer -
Tract -
O Bond Payment - A.D. - Bond
Assmt.
O Customer Deposit
O Other
m0
,}TOTAL $ �a
Remarks: ,� . `;?IiDSt`)f'_i�jf t:74 4(il li?,Q L T-)Oj I
OCopy to:
Cash
Water Service
Check
o!!
Money_
Cashier
Order
; ?q
CV6-438 (11189)
SANCO -
PUMPING SERVICE ( 2502 Morongo Trail
Palm Springs, CA 92264 ,
.(619)327
-8859 9642
�O. D TO
9XLESMAH
I TERMS
F.O.B.
STREET
STREET NO.
..NO._v
--3
i
CI STATE ZIP
CITY STATE ZIP
CUSTOMER ORDER f
9XLESMAH
I TERMS
F.O.B.
DATE n
i
boa
=h PAYMENT DUE`UPON RECEIPT