10867 (PLBG)P.O. BOX 1504 No. 10867
Building 78-105 46-845 GOLDEN SANDS LA QUINTAC
Address CALIFORNIA 92253
SCHLOTTHAUER
BUILDING: TYPE CONST.
OCC: GRP.
Mailing
Address SAME
A.P. Number
City
Zip
Tel.
LA QUINTA
Legal Description
Project Description
HOOKUP
ContractorSEWER
ECONO SEWER
Address
P 0 BOR 192
City
Zip
Tel.:
PALK DESERT
346-2793
State Lic.
City
& Classif. C42— 480961
Lic. # 342
Sq. Ft.
No. No. Dw.
Size
Stories Units
Arch., Engr.,
Designer
New ❑ Add ❑
Alter ❑ Repair ❑ 'Demolition ❑
Address
Tel.
City
Zip
State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that,m Ilcensed under provisions of Chapter 9 (commencing with Section
7000) of Divram
3 of theBu'siAessss and Professions Code, and my lice sq(is inn full force and
effect. `, 1 — ._^il u_ �l _ l.'k^ L 1 1
SIGNATURE T•—` 'DATE—
OWNER-BUILDER DECLARATION
I hereby affirm that I am•exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Susiness 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 rile 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 penafty of not more than rive 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 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
of proving that he did not build or improve for the purpose of sale.) .
O I, as owner of the property, am exclusively contracting with licensed contractors to con-
Estimated Valuation
$ 600
PERMIT
AMOUNT
Plan Chk. Dep. ,
Plan Chk. Bal.
Const.'.
,
Mech.
Electrical
Plumbing
$30.00
struct the project. (Sec. 7044, Business and Professions Code: The Contractor's Ucense- Law
does not apply to an owner or property who builds or improves thereon, and who contracts for
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
❑ I am exempt under Sec. B. & P.C. for this reason
.
S.M.I.
Grading
Driveway Enc.
Date Owner
Infrastructure
WORKERS' COMVENSATI,ONiDECLARATION
I hereby affirm that I have a certificatp-,gf �cgnsent to self -insure, or a certificate of
Worker's Compensation lnsurance; ora certified•r;op"thereof. (Sec.3800,Labor Code.)
PolicYd. Compahy�� r �
,pi(qr opy is filed with the city. ❑Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
n�x,gQn {f% 07A{ r'�A•,..1,{-�i'� id
ffj` 1;F��%N 3 i fj FiL JV.tlt
TOTAL
$30.00
REMARKS
(This section need not be completed if the permit is for one hundred dollars (8100) 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 Owner
NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become
subject to the Workers' Compensarion provisions of the Labor code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
ZONE: BY:
Minimum Setback Distances: -
Front Setback from Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY
Side Street Setback 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, Civil Code.)
Side Setback from Property Line
Lender's Name
FINAL DATE
INSPECTOR
Lender's 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.
Issued by:
Validated by:
Date Permit
Signature of applicant Date
Mailing Address
Validation:
City„ State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES 1
1ST FL. SQ. FT. ® $
UNITS
COLL. AREA
SLAB GRADE
YARD SPKLR SYSTEM
2ND FL. SQ. FT. 0
HEATING (ROUGH)
STORAGE TANK
POR. SQ. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SQ. FT.
DRAINAGE PIPING
WALL SQ. FT.
HEATING (FINAL)
DRINKING FOUNTAIN.
SQ FT ®
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
FINAL INSP.
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GRADING
cu. yd.
$ Plus -x$_=$
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
FINAL INSP.
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
FIRE ZONE ROOFING
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 1 Vi c
SEWAGE DISPOSAL
SQ.FT.GAR ® VVac
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
SEWER OR -STANK
UGH WIRING.
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
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 SIGNATURESIINITIALS
GARDEN WALL FINAL
COACHELLA VALLEY WATER DISTRICT
CASH RECEIPT DETAIL G ��
Received From: / •-- : tt 6E� Ott r ` v. z �� , i •r _ i K—•
Address: G ^ a � ( c-
Account No. ,G�Jpc
7v , 696 �t� 6 Lot(s) Z-
Service Address 4$4 �SoLDG�I Sf►�f_ 9L
❑ Meter(s)
❑ Service(s)
❑ Backflow(s)
❑ House Lateral(s)
❑ DetectorCheck(s)
❑ Meter Surcharge
t
k�atlon Capacity Charge /)1 `t SCi
❑ W.S.B.F.C.
❑ Temporary Constryction Meter
❑ Turn on Charge
❑ Uncollected Account - Name
❑ Inspection Fee - Tract -
Fee -
❑ Plan Check Fees Water / Sewer -
Tract -
❑ Bond Payment - A.O. - Bond
i
Assmt.
❑ Customer Deposit
❑ Other
Date:
Tract % �—
G.A. Code
I r
TOTAL $ ��