14462 (PLBG)P.O. BOX 1504 N o . 14462.. '
Building . _ 53-777 Ave. Villa - • 78-495 CALLE TAMPICO -
Address LA QUINTA, CALIFORNIA 92253
Owner David Lawson
BUILDING: TYPE CONST. OCC: GRP- -
Mai0q
Address P.O.. Box I028
_ A.P- Number
Cifv,; Zip Tel. y '
L.t. nt8 ,. .A. 92253 564-9210. Legal Description
ContractorProject Description Saver Connect
Address
City JZip' Tel.:
State Lic. City
& Classif.. Lic. # Sq. Ft. No. No. Dw.
Size Stories Units
Arch., Engr.,., _. -
Designer New ❑ Add ❑ Alter ❑ r Repair ❑' Demolition ❑
Address Tel.
CityZip State M
Lic. #
LICENSED CONTRACTOR'S DECLARATION _
1 hereby affirm that I am licensed under provisions of. Chapter 9 (commencing with Section'.
7000) of Division 3 of the Business and Professions Code, andmy license is in -full force and
• effect.
SIGNATURE - DATE '•
OWNER -BUILDER DECLARATION Estimated Valuation a'
I hereby affirm that 1 am exempt from the Contractor's License Law'for the following 41 .a 000.: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 /
requires the applicant for such permit to file a signed statement thatheis licensed.,pursuant•to PERMIT • r - '• AMQUNT
the provisions of. the Contractor's License Law, Chapter -9_(commencing with Section 7000).of -
Division 3 of the Busfness and Professbris Code, or that. he is exempt therefrom, and the basis-
for the afieged exemption. Any violation of Section .7031.5 by 'any applicant fora permit . Plan Chk..Dep'.
subjects the appficant to a civil penalty of not more than five hundred dollars .(8500).
❑ 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:"
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.
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 will have the burden • Electrical
of proving that he did not build or knprove for the purpose of sale.) '
❑'I, as owner of the property, am exclusively contracting with licensed contractors to coo- ,Plumbing 30. GO
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, and who contracts for S.M-l:.
such projects with a contractors) Licensed pursuant to the Contractor's License Law.) :. ..
Grading
❑ 1 am•exempt under Sec B. & P.C.. for this reason'
/J Driveway Enc. '
Date, !/ 1/9y Owner °� �Infrastructure
WORKERS' COMPENSATION DECLARATION 1�
I hereby affirm that I have a certificate of consent to self•insure,.or a certificate of I
.Worker's Compensation Insurance, or a certified copy thereof..(Sec. 3800, Labor Code.) -
Policy No. Company I
❑ Copy is filed with the city. ❑ Certified copy is hereby furnished.
TOTAL 30.00
CERTIFICATE OF EXEMPTION FROM REMARKS _j/
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 notes I
employ any person in any manner so as to become subject to the Workers' Compensation.
Laws of California
r
NOTICE,TO APPLICANT ff, 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
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND ' Side ,Street. Setback from Center -Line
SHALL S011JECT 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 Plropei3y Line
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND
ATTORNEYS FEES. FINAL DATE INSPECTOR
Thls is a building permit when properly.filled out, signed and validated, and.is subject to .
expiration if work thereunder is suspended for 180 days.
1 certity,that I have read this application and state that the above information is correct: Issued by: Date Permit
1 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: h
City, State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBIW FEES
1ST FL. SO. FT. ® $
2ND FL. SQ. FT.
POR. SO. FT. ® Yr
GAR. SO. FT. ®
CARP. SQ. FT. ®'
WALL SO. 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
BONDING
FLOOR DRAIN
MECHANICAL FEES
FORMS
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH) -
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APP./EQUIP.
LAUNDRYTRAY
AIR HANDLING UNIT CFM
TEMP. POLE
KITCHEN. SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET
COMPRESSOR HPr
POLE, TEM/PERM
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 ® 11/4 c
SEWAGE DISPOSAL
�/�%��'�� /n.. -� •� /,. ��
SO.FT.GAR @ 3/4c
HOUSE SEWER
VENTILATION -
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
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH) -
METER LOOP
HEATING (FINAL)
OTHER APP./EQUIP.
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 q
�/�%��'�� /n.. -� •� /,. ��
REMARKS:
VENTILATION -
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESJINITIALS
GARDEN WALL FINAL 7d
COACHELLA VALLEY WATER DISTRICT
CASH RECEIPT DETAIL
Received From: 1 v1
Address: C+?., -I. mac,
Account NO. w G - Lot(s)
Service Address r — = ,�°
❑ Meter(s)
❑7Semice(s
❑ 'Backtiow(s)
❑ House Laterals)
❑ ,�eLtoctor Check(s)
❑ Meter Surcharge
i,,\SanitationCapacity Charge r
❑W.S.B.F.C.
❑ Temporary Construction Meter
❑ Turn on Charge
❑ Uncollected Account - Name _
❑ Inspection Fee - Tract -
Fee -
❑ Plan Check Fees Water I Sewer -
Tract -
❑ Bond Payment - A.D. - Bontl
Assmt.
❑ Customer Deposit
❑ Other
)
Remarks:
❑Copy to:
Cash
Check L LL y
'Money y _
Order
N9 51275
1A- I(I-11`1
(
TOTAL
Water Service
Cashier
' CVWD-436(11189)