11049 (PLBG)S •
P.O. BOX 1504 Nd., 11049 '
Building 52„4445. Villa , 7&105 CALLE ESTADO
Address LA QUINTA, CALIFORNIA 92253 :
Owner ,
Waggoner
Mailing BUILDING: TYPE CONST: OCC: GRP.
Address same
A.P. Number
City - Zip 'Tel. -
La +3� 92253 "~ Legal Description
Contractor Project Description
Econo Sewer
Hook up
Address
1). a. Box 192
City Zip Tel.:. .Y
.�. 9226€i 346 ?-793
State Lic.City
& Classif. C42- 480961 Lic. # 342 Sq. Ft: No No. Dw.
Arch. Engr:, Size - - - ...Stories - Units -
Designer Demolition,❑ - y.'
Address Tel.•
City.. 7 -Zip State
Lic. #
N , LICENSED CONTRACTOR'S DECLARATION -
I hereby affirm the I am licensed under provisions of Chapter 9 (commencing with Section '
7000) of Division 3 of We Business and Professions Code, and my license is in full force andq
_effect
:SIGNATURE 16 COs 1 DATE 4 .. .. ..r
' OWNER -BUILDER DECLARATION ation. ti
I hereby affirm th�l am exempt fromEstimated Valu
'the Contractor's License Law for the. following .... 300.:00
reason: (Sec. 7031.5;Business agd':Professions Code; Any city or•county which requires a. -
permit to construct, alter; timprove, demolish, or repair any structure, - prior to its issuance also - 4
requires the applicant -for such permit to rile a signed statement that heis licensed pursuant to _ PERMIT _ - AMOUNT i •'
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,ot Section 7031.5 Dy 'any'applicant .for apermit..-Plan,.Chk. Dep. _
subjects the applicant to a civil penalty of not more than five hundred dollars .(E500). 'a _a
••❑ ,I, as;owner of the property, or my,employees with -wages as their sole compensation; will Plan Chk. Bat,
do the work, and the structure is not intended or offered for sale. (Sec. •7044, Buisness and v
Professions Code: The Contractor's. License law does not apply to an owner ofpropertywho . ..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 safe. ff. however," the building - Ee
or improvement.is sold within one, year of completion, the owner -builder will have the burden Electrical
of proving thathe did not build or improve for the purpose of sale.).
❑ I, as owner of the property, am exclusively contracting with licensed contractors.to con- Plumbing �� - �n
slruct- the. project. (Sec: 7044,' Business and Professions Code: The Contractor's License Law ° v .1A
A�
does not apply to an ownerof.property - who builds or improves thereon_ and whocontracts -for - S:M.I. • - . -
•- such projects with a contractor(s) licensed pursuant to the'Contractor's License Law.) - _
Grading
•� .•. O lam exempt under. Sec. B: & P.C. for this reason
Driveway Enc. '
4
Date Owner ' : Infrastructure '
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate.of consent to self -insure; of a certificate of _
Worker's Compensation Insurance; or a certified copy thereof. (Sec.. 3800 Labor. Code.), i
Policy No. Company
d1copy is filed with the city., El Certified copy is hereby furnished.
TOTAL 30.00
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.)-. .- .. Ftr, ,x r. ,r :r.'Ki-If an:_ vu- ��.ar.,
I certify that in the performance of thg work for which this permit is issued, I shall not s� t � �"'eS 04
'employ any person in any manner so•as to become subject to the'Workers' Compensation` "
Laws of California.
Date Owner "
NOTICE: TO APPLICANT., If, alter 'making this Certificate of &emption you should become ZONE:
subject ,to the. Workers"' Compensation provisions of the Labor Code, .you must forthwith MinimumSetback-Distances: -'
comply with such provisions or this permit shall be deemed revoked. = - - _ . - ,
"Front Setback from Center Line
Rear Setback from Rear Prop. Line' a
CONSTRUCTION LENDING ACENcIf ` Side StreetSetback from Center Line
I hereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. -3097, CivitCode.) . • Side Setback from Property Line +:•
Lender's Name
Lender's Address
This is a building permit when properly filled out;'signed and validated, and'is subject to FINAL DATE ' ' INSPECTOR
expiration if work thereunder is suspended for 180 days. ' • • ' .
I certify that I have read this.application and state that Ahe 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.. + s, Validated by: i
Signature of applicant Date
Mailing Address Validation:
City, State, Zip t
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
2ND FL. SO. FT.
POR. SO. FT. ®
GAR. SO. FT. ®
CAR P. SO. FT.
WALL SO. FT. ®
SO 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.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APPJEOUIP.
LAUNDRYTRAY
AIR HANDLING UNIT CFM
TEMP. POLE
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
FINAL INSP.
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1% c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ic
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
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.
FRAMING
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING:
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION•
V
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
Receiveq From.,„`/
Address:
Account No. % Lot(/g)
Service Address
❑ Meter(s)
❑ Service(s)
❑ Backflow(s)
F
❑: House Lateral(s)
C1 ''Detector Check(s)
❑ MeterSurcharge
Capacity Charge
❑ W.S.B.F.C.
❑ Temporary Construction Meter
❑ Turn on Charge
F, ❑ Uncollected Account - Name
❑ Inspection Fee - Tract -
r Fee -
❑ Plan Check Fees Water I Sewer -
Tract -
❑ Bond Payment - A.D. Bond
Assmt.
❑ Customer Deposit
❑ Other
Remarks:
❑Copy to:
Cash
Check
Money
Order
i
TOTAL
Z 2,l23
Water Service
Cashier.
CVWD-438 (11189)