10865 (PLBG)Building
Address 46-255 WASHINGTON
Owner
W. W. WEBER
Mailing
Address SAKE
City Zip
LA QUINTA 92253
Contractor
STEPk'EN PLUMBING
Address
53-210 AVE 44
City Zip.
State Lic.
& Classif. .565175
;
Arch., Engr.
Designer
Address
City
- L
A'"I hereby affirm hat I am
701X)) of Divisionrt3'of am
effect. . b' /
Zip
4
tIGl�GV - .
P.O. BOX 1504
7&105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
Tel.
345-4622
345.4353
I City
Lic. # 1
Tel.
State
Lic. #
DECLARATION '
of Chapter 9 (commencing with Section
Code, and my license,is in full torce and
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 Jts issuance also.
requires the applicant for such permit to file a signed statement that he is licensed pursuant to
the provisions or the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Division 3 of the Business and, Professions Code, orthat. 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 rive hundred dollars.($500). . .
0 1, 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, Bussness and
Professions Code: The Contractor's_ License Law does not apply to an owner of property who -
builds or improves thereon and who doessuch work himsell•or' through -his own employees,
provided that:.such improvements are not intended or offered *for sale. n,. 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.)
❑ I, as owner of the property, am exclusively contracting with licensed contractors -to con-
struct the project. (Sec. 7044, Business and Professions Coder The Contractor's License Law
does not apply to an owner of property who builds or improves thereon, andwho contracts'for
such projects with a contractor(s) licensed pursuant to the Contractor's'License Law.)
❑ 1 am -exempt under Sec. B. & P.C. for this reason
Date Owner
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
in,
Copy isfiled.with the city. - ❑ Certified copy is hereby.furnished.
fXCERTIFICATE 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 the 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
aliforniaDate Owner
NOTICE TO APPLICANT. If, alter making this Certificate of Exemption you should become
subject to' the •Workers' Compensation provisions of the Labor Code, you must forthwith
comply withsuch provisions or this permit shall be deemed revoked.
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. (Seca 3097, Civil Code.)
Lenders Name
Lenders 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 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
No. 10865
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number
Legal Description
Project Description SEVER HOOKUP
Sq. Ft. No. No. Dw.
Size Stories Units
New ❑ Add ❑- Alter ❑ Repair ❑ Demolition ❑
ZONE:
BY:
Minimum Setback
Distances:
Front Setback from Center Line
Estimated Valuation
$1,500
PERMIT
AMOUNT
Plan .Chk. Dep.
Side Setback from Property Line
'Plan=Chk. Bal.
INSPECTOR
Const:
Date Permit
Mech.'
Electrical
Validation:
Plumbing • .
$30.00
S.M.I. .
Grading
Driveway Enc.
Infrastructure
IV n4_ S4
TOTAL
.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
FJNAL DATE
INSPECTOR
' Issued by:
Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEF,S
1ST FL. SQ. FT. ® $
2ND FL. SQ. FT.
POR. SO. FT. ®
GAR. SO. FT. ®
CAR P. SO. Fi.
WALL SQ. FT.
SQ FT ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN.
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
HEATING (ROUGH)
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
DUCT WORK
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
HEATING (FINAL)
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
BOND BEAM
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1Vi c
SEWAGE DISPOSAL
LUMBER GR.
SO.FT.GAR ® 3/ic
HOUSE $EWER
FRAMING
FINAL INSP.
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PLCK.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 !21//211
OUGH WIRING.
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP.IEQUIP.
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
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINMALS
GARDEN WALL FINAL
Remarks:
TOTAL $
COACHE" VALLEYJW ATER DISTRICT
CASHH-RECEI DETAIL
Received From:
Address: 4A-�---z
Date.
Account No—
Service Address L4-
Lot(s)".. Tract --._
7:-Z U
1:1 Metbr(s)
G.A. Code
0 Service(s)
$
11 Backflow(s)
0 House Lateral(s)
0 Detector Check (s)
0 Meter Surcharge
• O'fanitation Capacity ChargeAX
0 W.S.B.F.C.
0 Temporary Constructidh Meter
0 Turn on Charge
0 Uncollected Account - Name
0 Inspection Fee - Tract -
Fee -
11 Pian Check Fees -Water Sewer
-
Tract -
0 Bond Payment - A.D. -- Bond
• Assmt.
—
11 Customer Deposit
0 Other—
Remarks:
TOTAL $