10512 (PLBG)P.O. BOX 1504 N o . 1 512
78.105 CALLE ESTADO
Address 53--385 Eise :haver LA QUINTA, CALIFORNIA 92253
Mer -ox Corporation
Mailing
BUILDING: TYPE CONST. OCC: GRP.
Address
A.P. Number
City
Zip
Tel.
#,a Qui>nsta
Legal Description
Project Description
Contractor
Lcono Sewer
Hook Up
Address
P. 0. Box 192
City
Zip
Tel.:
P.D.
1 92263
346--2797
State Lic.
City
& Classif. 48096.2
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 I am licensed under provi`slons of Chapter 9 (commencing with Section
7000) off Division 3 of the Business and Profe`sslons Code, and my license is in full) fforce and
4ftect 1 E` .. f _//. "E'er`
- ..
SIGNATUREr DATE
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 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 r7000) of
Division 3 or 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 penalty 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 or completion, the owner -builder will have the burden
Of proving that he did not build or Improve for the purpose or sale.) -'
Estimated Valu tionn
PERMIT AMOUNT
Plan Chk. Dep.
Plan Chk• Bal.
COf1St. —
. Mech. •�
Electrical
� . (� ('
Plumbing 30.00.
O 1, as owner of the property, am exclusively contracting with licensed contractors to con-
struct the project:, (Sec. 7044, Business and Professions Code: The Contractor's License Law
does not apply to an owner of property who builds or Improves thereon, and'who 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
.
S.M.I.
-
- Grading
Driveway Enc.
Date Owner
Infrastructure
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.certifled_copy thereof. (Sec..3800,.Labor Code.) -
Policy No. om
opy Is filed with the city.❑ Certified copy Is hereby furnished.
l`S13 `r!.{ A 41 8 ,) ^16-9`
TOTAL `V 3tJ:' f�' A 1 a1r' a . V. V11
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
REMARKS
(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 thg work for which this permit Is Issued, I shall not
employ any parson 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' Compensation 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
Ihereby 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
Issued by: Date Permit
y
Validated by:
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 Js correct.
I agree to comply with'ail 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
Malling Address
Validation:
City, State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBINGFEES
1ST FL. SQ. FT. ® $
UNITS
SLAB GRADE
2ND FL. SQ. FT.
BONDING
YARD SPKLR SYSTEM
POR. 50. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
FOUND. REINF.
GAS (ROUGH)
DRAINAGE PIPING
CAR P. I SO. FT. ®
I
REINF. STEEL
WALL 5Q. FT.
TEMP. POLE
DRINKING FOUNTAIN.
SQ. FT. ®
GROUT
URINAL
ESTIMATED CONSTRUCTION VALUATION $
FINAL INSP.
WATER PIPING
NOTE: Not to be used as property tax valuation
WATER SYSTEM
FLOOR DRAIN
MECHANICAL FEES
=$
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
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.
SO. FT. ® c
BATH TUB
SPARK ARRESTOR
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1% c
SEWAGE DISPOSAL
LATHING
SQ.FT.GAR ® Vhc
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
SEWE l
OUGH WIRING.
DUCTWORK
ROCKSTORAGE
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
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION/ 'Rl j Z
c
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
a
COACHELLA VALLEY WATER DISTRICT
CASH RECEIPT DETAIL
Received From: ) r T-i<_� /--(-.C7[[ r.f•t J--/1 LA 1
Address: 4,). '1 `-'y%C'� Y? � (_U-Zn_ .4 4,,l & L
Account No. � -, Lot(s)
Service Addresses ' �� (.`'.-// /-�C_%l:<.•'' /i ��L
❑ Meter(s)
❑ Service(s)
❑ Backllow(s)-_
❑ HouseLate ra.l(s)
❑ DetectorCheal.(s)
❑ M at er Surc hai g
P,.S9-nitationCapacity Charge D/ J r
❑ W.S.B.F.C. '-- _
❑ Temporary Construction Meter
❑ Tum on Char_tr, __
❑ Uncollected Account - Name -
0 Inspection I' oe - I Tact -
Fee -
❑ Plan Check rep:; Water ! Sewer -
Tract -
❑ Bond Payment A.D. --Bond
Assmt. '
❑ Customer Deposit.
❑ Other
a ""35,963,
TOTAL $ 1 -7D-
T1
D_
Remarks: ` `(%i'f.,y�, t.t1j t t'
❑copy to:
Cash _ - Water Service
Check
Money ! Cashly
Order ; VVVW- 38(11189)