14350 (BLCK)Building 54-355 Eisenhower
Address
Owner flavin. Ross Miller
Mailing
Address P.O. Box 722
city a Qq nt.a ¢ . CA zip 9 253
Contractor
Pacific .braces
Address
City lZip
State Lic.
& Classif.. a3' 4253.81
Arch., Engr., -
Designer
Address
f44
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Tel.:
City
Lic. #
Tel.
City Zip ( State
Lic. #
`LICENSED CONTRACTOR'S DECLARATION
I her\ affirm that lain licensed under provisions of Chapter;g (commencing with Section
i7000)Yof iytsion 3 of3he Business and Professions Code, and mv%cense is in full force and
No. 14350
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number
Legal Description
Project Description 60 t of a1. high block wall
Sq. Ft. No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
OWNER -BUILDER DECLARATION
I hereby affim\hat I am exempt from the Contractor's License Law for the. following
Estimated Valuation
reason: (Sec. 7031.5,Business and Professions Code: Any city or county .which ,requires a'
PERMIT
permit to construct, after. Improve, demolish, or repair any structure, prior to its issuance .also
requires the applicant for such penult to fine 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
Plan Chk. Dep.
subjects the applicant to a civilpenally of not more than five.hundred dollars (5500).
O I, as owner of the property, or my employees with wages as their sole compensation, will -
Plan Chk. Bal.
Const.
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 inproves thereon and who does such work himself. or through his own employees,
provided that such improvements are not intended or offered for sale. It, however, the building
.. McCh-
or Improvement is sold within one year of completion, the owner -builder will have the burden
ofproving that he did not build or improve for the purpose of sale.)
Electrical
Plumbing
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-
struct the project. (Sec. 7044, Business and •Prolessions, Code: The Contractor's License Law
does not apply to an owner of property who builds or Improves thereon, and who contracts for -
.
S.M.I. .
such projects with a contractorfs) gcensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec- • H. & P.C. for this reason
Grading
Driveway Enc.
Date Owner Infrastructure
WORKERS' COMPENSATION DECLARATION '
1 hereby affirm that 1 have a certificate of consent to self -insure, or a certificate of
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.) -
PoIIcY Pd.00 � Company
Pdopy is filed with the city. O Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed ff the permit is for one hundred dollars ($100) valuation
or less.)
I certify that in the performance of UV work for which this permit is issued, I shall not -
employ any person In any manner soas to become subject to the Workers' Compensation -
Laws of California
Date Owner
NOTICE TO APPLICANT: ff, after maI&V this Certificate of Exemption you should become
subject to the Workers' Compensation provisionsof the - Labor Code, you must forthwith
comply with such provisions or thfs permit shall be deemed revoked.
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND
SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP�TO ONE
HUNDRED THOUSAND DOLLARS ($1110,000), IN ADDITION TO THE COST. OF COMPENSATION,
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND
ATTORNEY'S FEES.
This•Is a building permit when properly filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 160 days. .
I certify that.l 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-.
mentloned property for inspection purposes.
Signatureof applicant Date
Mailing Address
City, State, Zip
TOTAL
REMARKS
,082.00
AMOUNT
45.00
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop..Line
S de Strjt Set I from Center Line
t �t� _= Set Ick f rODertv Line -
FINAL Di
Issued b)
it
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBIWU FEES
1ST FL. SO. FT. ® $
UNITS
I.
COLL. AREA
SLAB GRADE
YARD SPKLR SYSTEM
2ND FL. SO. FT. p
HEATING (ROUGH)
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
ROUGH WIRING
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
FOUND. REINF.
GAS (ROUGH)
DRAINAGE PIPING
CAR P. I SO. FT. ®
HEATING (FINAL)
WALL SO. FT. ®
REINF. STEEL
DRINKING FOUNTAIN
SO. FT. ®
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
SERVICE
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GRADING
cu. yd.
plus
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
FINAL INSP.
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET*
COMPRESSOR HP
I POLE, TEMIPERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SO. FT. ® c
BATH TUB
FIREPLACE
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1'/a c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ic
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 SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP.IEOUIP.
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
/ / //I Yj
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL
•tJ
COACHELLA VALLEY WATER DISTRICT
j CASH RECEIPT DETAIL
Received From: `- C' , . f. ; . .-'I , ..; i I `_-/ � . ,. %-- �...
7 (? Y (c 1 Z e,i �i � .A
Address: L) (�
Account No. Lot( y
Service Address S 4-7
l
Meter(s)
[AService(s) '
❑ Backflow(s)
❑ House Laterals)
❑ DetectorCheck(s)
❑ Meter Surcharge �-
sanitation Capacity Charge J
❑ W.S.B.F.C.
❑ Temporary Construction Meter
❑ Turn on Charge
❑ Uncollected Account - Name
❑ Inspection Fee - Tract -
Fee -
❑ Plan Check Fees Water / Sewer -
Tract -
❑ Bond Payment - A.D. - Bond
Assmt.
❑ Customer Deposit
❑ Other
Remarks:
TOTAL
NQ Woq