14672 (PLBG)kN /
Address 52-795 AVE VUJA r
Owner
Mailinq�
Addresal�
City Zip
.FJM EESM,... 92260
Contractor
Address . .
City "
P.O. BOX 1504 N o . 14672
.
78-495 CALLE TAMPICO
LA OUINTA, CALIFORNIA 92253.
BUILDING: -TYPE CONST: OCC: GRP.
A.P. Number
Tel.
56&itt34- i9 Legal Description .
Project Description
Tel.:
State Lic. City
& Classif.. Lic. # Sq. Ft. No. No. Dw.
Size.- Stories Units •
Arch:, Engr.; -
Designer New ❑ Add ❑
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.,
.. provided that such improvements are not intended or offered for sale. If, however,' the building
rk th'
'
SIGNATURE DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law forthe following
Estimated Valuation.
reason: (Sec. 7031.5,Business •and- Professions ..Code:, Any city or-, county which. requires a
permit to construct, after, improve, demolish; or repair anystructure, prior to its issuance. also
requires the applicant for such'permif to file a signed statement that he is licensed pursuant to
O I, as owner of the property, am exclusively contracting with licensed contractors to con-
PERMI'T':
the provisions of the Contractor's License Law,. Chapter 9 (commencing. -with Section 7000) of
BY: -
Olvlslog.,3 of the Business and Professions Code, or that. he Is exempt therefrom,, and the basis .
the alleged exemption 'Any violation of: Section 7031.5 by any, applicant for a permit
fO,Wcts
the applicant to a civflpenaltyofnot more than five hundred dollars ($500). owner of the'properfy, or my employees with wages as their sole compensation, willPlan'Chk.
_
Plan Chk. Dep. '
Bal.
he 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
Const.' ,
'
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
rk th'
or Improvement is sold within one year of completion, the owner -builder will have the burden
Electrical
of proving that he did notbuild or improve for the purpose of 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
BY: -
does not apply to an owner of property who builds or improves thereon,, and who -contracts for
S.M.I. -
such projects with -a contractors) licensed pursuant to the Contractor's License Law.) -.
Front Setback from Center Line
Grading
O 1 am exempt under Sec B. 8 P.C. for this ason
Rear Setback from Rear Prop. Line
WARNING: FAILURE TO SECURE WORKERS'COMPENSATION.COVERAGEIS UNLAWFUL. AND
Driveway Enc.
Infrastructure
Date Owner `'
SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE
WORKERS' COMPENSATION DECLARATION
` I hereby affirm that 1 have a certificate of consent to self -insure, or a certificate of
$
Worker' Co ensatio 1 saran r a IUed�Qpa`�, tthe�re,¢. 00, Cgd%gS
Poll cy ivo" ��"��•� pany t Y� Vl ��1 iiYiJrr'C
Do
❑ Copy is filed with the city, ❑ Certified copy is hereby furnished. '.
ATTORNEY'S FEES.
TOTAL
CERTIFICATE OF EXEMPTION FROM
REMARKS
WORKERS' COMPENSATION INSURANCE
,INSPECTOR'
(This section need not -be completed ff the permit Is for one hundred dollars ($100) valuation
-
' or less.) '
I certify that in th rt f th f h' h
I certify that I have read this application and state that the above information is correct.
Alter ❑ Repair ❑
Demolition:❑.` '
e pe onnance o s wo or. w is is permit is issued, I, shall not
' employ any parson in any.manner-so as to become s5b`ject to the Workers` Compensation
Laws of California ;.
date �''� ✓
Owner t ��"1
NOTICE TO APPLICANT:_:M, after making, thf5 Certificate of Exemption' you. should become
ZONE.
BY: -
Nubject to the Workers' Compensation provislons of •the Labor Code; you must forthwith • .
omply with such provisions or this permit shall be deemed revoked.
,
Minimum Set back Distances:
Front Setback from Center Line
•
Rear Setback from Rear Prop. Line
WARNING: FAILURE TO SECURE WORKERS'COMPENSATION.COVERAGEIS UNLAWFUL. AND
Side Street Setback from Center Line
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,
$
Side Setback from Property Line
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, .INTEREST, AND '
ATTORNEY'S FEES.
7hisls a building permit'when properly filled out, signed and validated, and is subject to.
FINAL DATE
,INSPECTOR'
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.
Issued by:
Date ` Permit !
I agree to comply with all city and county ordinances and state laws, relating to building
n
construction, and hereby. authorize representatives -of. this- city to enter the above-.
r
i Q
.
mentioned property for inspection purposes.
Validated by:
I JI
Signature of applicant Date'
Mailing Address
Validation:
City, State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBINU FEE
IST FL. SO. FT. ® $
UNITS
SLAB GRADE
2ND FL. S0. FT.
BONDING -
YARD SPKLR SYSTEM
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SO. FT.
GAS (ROUGH)
DRAINAGE PIPING
WALL SO. FT.
OTHER APPJEOUIP.
DRINKING FOUNTAIN
SO. FT. ®
TEMP. POLE
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GROUT
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SYSTEM
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FRAMING
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
REMARKS:
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 ® 1+/e c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/4c
HOUSE SEWER
MESH
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
SEWE R
ROUGH WIRING
DUCTWORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
v,-
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.
Q FINAL INSP.
FRAMING
FINAL INSP. a ¢
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 SIONATURESIINITIALS
GARDEN WALL FINAL
COACHELLA VALLEY WATER DISTRICT
Nk "Itit
CASH RECEIPT DETAIL
Date: 31
Received From:
-
h� Wa. cti`, rti -Woo P0. 2.,
Address:
'
Account No. (Od L
O ( • �' Lot(a) .. Tract
Service Address S; - -7 9 Y
e,� �' �� `vvj 1 G.A. Code
❑ Meter(s)
$
❑ Service(s)
❑ Backflow(s)
❑ House Lateral(s)
0 Detector Check(s)
❑ MMeeterSurcharge
ff Sanitation Capacity Charge
` J�.�
�,5 OJ
❑. W.S.B.F.C.
❑ Temporary Construction Meter
❑ Turn on Charge
y
❑ 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:
BUILDING DEPA;RTI`IENT
CITY OF LA QUINTA
OFFICE: (619) 777-7012 INSPECTION REQUESTS: (619) 777-7153
GO:. DATE: �S
CORRECTION NOTICE
'ERMIT NO. _�d 47Z //. /��; TIC t �vr%d�✓:
Ins ector
s BUILDING DEPARTMENT
CITY�OF LA QUINTA
OFFICE: (619) 777-7012 INSPECTION REQUESTS' (619) 777-715.3
f
TO: DATE: � J
ADDRESS: �7g�
CORRECTION NOTICE
PERMIT NO.017e
,07vW41
icy/ � ,eats'
-/4
Ins+ector
1:.
. F
Ins+ector
T HEARD & • HOLCOMB
PLUMBING _& SEWER
,¢
'P.O. Box 1829
HEMET, CALIFORNIA 92343
Phone 658-3016 6798919.
' • Contractor Lic. #C36SC428334418 .' 5 `
NAME
� - .._ ;
-
DATE
ADDRESS
6e�
CITY
PHONE
MAKE q
Y �, •
DEL
SERIAL NO. - -
w
❑ C.O.D:
V
y
'El CHARGE
NATURE OF SERVICE•- '�
-
_ - • _
PROMISED
•PART NO.
DESCRIPTION
PRICE AMOUNT
a�
2
4
t
+
•
5
*
9
~* 7
10
r'
c'
12
COMMENTS
- -
'TOTAL
-,MATERIALS
i
i
. TECHNICAL
SERVICE
-
Z
. o� .`., _ •.
w
_TIME
s•
f
••
DAW COMPLETED-
/ / r
-TAXA
TECHNICIA
l
c
CASH OF WORKLE-► TOTAL
,
Signature below constitutes-acce taince of,abo've. '"CY
UWE service performed as being satsfacto' — and t . that equipment has been left',in good condition.
-. 107 .� , _ �^=
86 ,
Z . k'' . ' See reverse side for Guaranty -
1
Fr I endly ►1essagr from your Ser��i�e Van! i
OUR POLICY
We try sincerely to handle every service call honestly, efficiently —
and at a fair pries! Should you ever havQ a question regarding our
work, please feel free to bring it to us.
OUR GUARANTY
"Thjs invoice shows charges for this repair -job (?nly. ,We-guafanty,only -
that the Barts installed by us will perform satisfactorily under eondf-
tions of normal usage for a period of ninety days after date.of repair.
EXCEPT AS EXPRESSLY JPRQVID.ED ABOVI=,-THERE_ t5 Nor WAR-
RANTY OR GUARANTY OF MERCHANTABILITY, OR FITNESS FOR
A PARTICULAR PURPOSE, OR OF ANY OTHER KIND, EXPRESS OR
IMPLIED, WITH RESPECT TO THE SERVICES PERFORMED OR
PARTS FURNISHED BY US, and we do not, of • course, make any
guaranty with respect to any other parts. If repairs later become ncc-
essary due to other defective parts, they will be charged separately."
Promissory Notes should be made in duplicate with one copy for customer To make
a copy simply Insert a carbon between the sheets - or detach and fill out _each copy.
separately
PROMISSORY NOTE" -
$ Date-_ .19 —
For Value Received, 1, ----
Promise to pay to the order of
the sum of._—__--- -- -------.--
to be paid as follows, — --
with interest to be paid, at the rate of
E _ .
per cenibm per' annum, from date payment is due.
_L.S.
(FOR SIGNATURE OF CUSTOMER)
I L.S.
{ADDITIONAL SIGNATURE IF AVAILABLE)
SIGNED AND SEALED IN PRESENCE OF:
e
(WITNESS)
M P1.00K) 3214 Imi G _+ Mea -OW -1 %0," Pfelf MI CIE W" PPS -C81 - -
t - 1 g'•