13441 (PLBG)4
4
' P.O. BOX 1504 ' No. i3'44.1
Building', 51-835 Ave. Navarro, 78-105 CALLE ESTADO :
Address LA QUINTA, CALIFORNIA 92253
Owner. r Jack LOO :3. +r.
BUILDING: TYPE CONST. OCC: GRP.
Mailing
Address • • A.P. Number
CityZip Tel.u.-,-
Legal Description Sewer Connect
Coate aac. o
MI
/;r33uj,ld,vr Project Description
- r
Address.
en
Laws of California.
City
Zip
Tela
State Lic. ',
& Classif.
City
Lic. #
Sq. Ft.
Size
`No. No. Dw.
Stories Units
Arch:,-Engr., y ... _ .. - - - -� - - --
Designer
New ❑ Add'❑
._
Alter ❑ Repair ❑ Demolition ❑
Address
Tel.
City
Zip
State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of the Business and Professions Code, and my license is in full force and '
effect.
+
SIGNATURE DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractors 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 file 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
sujects the applicant to a civil penalty of not more than five hundred dollars.($500).
0i 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.) _ i .
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-
• strucl 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
Estimated Valuation
tf 1s
r $1,.200 x,00
-
-
PERMIT -
•J -AMOUNT
Plan Chk. Dep.
.,
Plan Chk. Bal.
-Const.
Mech.
Electrical
.. '
Plumbing
y
-
.S•M•1.
Grading
-
Driveway Enc.
,
Infrastructure
WORKERS' COMPENSATION DECLARATION
I hereby affirm that'I have a certificate of consent td self -insure, or.a certificate of
Worker's Co pensatio9g-�Insurance, r a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. g. 'r� frvi Company
❑ Copy is filed with the city. O Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
• WORKERS' COMPENSATION INSURANCE
(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 sub'Iect to the Workers' C t
Com
TOTAL
REMARKS
'+
.
-
i
sa on
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.
CONSTRUCTION LENDING AGENCY
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.)
Lender's Name
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 sof this city to enter the above-.
mentioned property for inspection purposes.
Signature of applicant Date
Mailing Address
City, State, Zip
ZONE: '' BY:
Minimum Setback •Distances:
Front Se_t_back_from-Center-Line
Rear SetbaEtrom Rear Pro( Line
t
Side Street"Set1Jack f9n Celnner, Line
,i` Setback from Property Linetl
�IAPR 2 9,1994 .�U�� {
FINAL DATE h� " 4NSPECTOR I
Issued by: /ba ' j
v
Validated by:T.
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEE"' ,
1ST FL. SQ. FT. ® $
UNITS
`
2ND FL. SQ. FT.
BONDING
YARD SPKLR SYSTEM
FOR. SQ. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SQ. FT.
GAS (ROUGH)
DRAINAGE PIPING
WALL SQ. FT.
OTHER APPJEOUIP.
DRINKING FOUNTAIN.
SQ FT ®
TEMP. POLE
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GROUT
WATER PIPING _
NOTE: Not to be used as property tax valuation
.,-_
FLOOR-DRAIN:—
MECHANICAL FEES
MECHANICAL
WATER SYSTEM
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FINAL INSP.
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
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.
SQ. FT. ® c
BATH TUB
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
GAR. FIREWALL
SQ.FT.GAR ® 3/ac
HOUSE SEWER
LATHING
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 LD
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 r
J "
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
CASH RECEIPT DETAIL
Received From: Lam►; A� ( 41n Z -Date: --.2
Address: 1-1 1�7 Qef)'WL till I W 1T��-r'��r �o? G� !FA 4 e-A-Ta
Account No. — Lots) Tract
Service Address,�Ll1LA ✓2 ,& A E G.A. Code
❑ Meter(s) s $
❑ Service(s)
❑ Backflow(s)
k
❑ House Lateral(s)
❑ DetectorCheck(s)
k
❑ Meter Surcharge
anitation Capacity Charge �1 r C T9 715
❑ W.S.B.F.C.
❑ Temporary Construction Meter
❑ Turn on Charge
❑ Uncollected Account - Name
❑ Inspection Fee - Tract -
Fee -
❑ Plan Check Fees Water I Sewer -
s;.
Tract -
❑ Bond Payment - A.D. - Bond
Assmt. *�
❑ Customer Deposit
❑ Other
TOTAL $ '� c vo
Remarks: 4P 2—
l� 1 j1 E, l/ 6 6—Xi 1/��11 @r�c� L� r 7 /-I lei/`I
C3 COPY to:
Cash Water Service
Check-
Money � E63¢ Cashi ' 1
Order H CVWD- 11/89)
77
APR-27-1994 09: 48AM FROM THE MAIL STAT I 0,N ' _. To 16197777011` ' P'. 01 r.*
,
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♦ys
FAX TO;; 619-777-7011
.
; Attn. Kelly
Dept. of Building & Safe ty,City of La' Ruinta,"'CA,'.+k"
DAN JONES has,,hW authority to. app ly for all, permi is and do all work necessary' `
relating to sewer connection at 51-835 Avenida Navarro,:-La Quinta', CA 92253:'0
State Compensation Insurance Fund policy .numberris 761545, as per attached
endorsement agreement, together with,copy of our �iatest biiiin9 showng that
r
continuous policy # 761545 is currently '
yin effect. ?Jean L
md. n, Co-Owner• ..n
If any additional information is needed, please`,caT;l co-owner Jack lopa:n at;
714-846-4564, `'
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