PLBG (10539)Building -. 52_279 Navarro
Address
Owner
Pete Knudsen
Mailing
Address same
La, Quiata Zip
p92253
Contractor
• Owner/Builder
Address
City
Zip
W.
P.O. BOX 1504 No. 10539
78-105 CA,LLE ESTADO
"LA`QUINTA; CALIFORNIA 92253
BUILDING: TYPE CONST. - OCC: GRP.
A.P. Number '
Tel.
564-2410 Legal Description
Project Description
Sewer H06k Up
State Lic.
City
& Classif.
Lic. #
Sq. Ft.
' No. No. Dw.
Arch., Engr.;
Size
Stories Units
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
70 OO) of Division 3 of the Business and Professions Code, and my license is in full force and .
effect.
_SIGNATURE DATE
'
' OWNER•BUILDERDECLARATION-
Estimated Valuation
I hereby affirm that I am exempt from the Contractor's License Law for the following'Q
/� : {� Q
reason: (Sec. 7031.5,Susiness and Professions Code:. Any city or county which requires a
permit to construct, after, improve, demolish, or repair any structure, prior to Its Issuance also
-
t3
-'
' requires the applicant for such permit to file a signed statement that he Is licensed"pursuant to
PERMIT
_
+ AMOUNT
.the
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
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.
- - -
._. ' suklects the applicant to a civil penalty of not more than five hundred dollars.($500). - •' - "' �:"
%:
._
Plan Chk. Bal.
.. ,
120', 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 Ucense ,,Law does not apply to an owner of property who.
COnst.. , • -
i
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,
Mech.
•
or Improvement Is sold within one year of completion, the owner -builder will have the burden -
Electrical -
r -
'
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-,
Plumbing
fl� ,
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.
: S.M.I.
_
- -
• such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
O 1 am exempt under Sec. /'Ir B. & P.C. for this reason -->
Grading
i
Driveway Enc.
Date Owner ? rt. a t'...:'�,_*.`
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 certified copy. thereof. (Sec. 3800, Labor Code.) ..
Policy No. company..,
❑ Copy is filed with the city. ❑ Certified copy Is hereby furnished.
TOTAL
30.00
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 thip work for which this permit Is issued,.l shall not
__ _ _ _. _ _ _
e -i°7 il.r��c" ,`r iC.?...f _�``
[@ _ ;<" (, a i 3
employ any person in any manner so' as to become subject to the Workers' Compensation
Laws of California.
'Date K! �% � if"�.flt,.+•-^''ems
'
Owner t.' .f� t
NOTICE TO APPLICANT.@ _'her (making this—Cerlificate of Exemption you should become
'ZONE:
- BY:, --
subject to. the Workers' Compensation provisions of the Labor Code, 'you must forthwith
comply with such provisions or this permit shall be deemed revoked. ..
.Minimurn Setback Distances: -
Front Setback from Center. Line
Rear Setback from Rear Prop. -Line
CONSTRUCTION LENDING AGENCY
Ihereby affirm that there is a construction lending agency for the performance of the
a
Side Street Setback from Center Line
work for which this permit is issued. (Sec. 3097, ClvilCode.)
$Ida Setback from Property Line
Lender's Name
Lender's Address
FINAL DATE
INSPECTOR
This is a building'permit when properly filled out, signed and validated; and is subject to
expiration It work thereunder is suspended -for 180 days.
I certify that I have read this application and state that the above information Is correct.
Issued by:
Date Permit•
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.
Validated by:
Signature of applicant r Date
Mailing Address
Validation:
City, State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES.
1ST FL. SO. FT. @ $
2ND FL. SQ. FT. Q
FOR. SQ. FT. ®
GAR. SQ. FT. ®
CAR P. SQ. FT.
WALL SQ. 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.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APPJEOUIP.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
TEMP. POLE
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
IWATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® V4c
HOUSE SEWER
REMARKS:
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 S AIR COND. SOLAR
SETBACK
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER &R GGRi1Fr;F
GH WIRING.
DUCT WORK
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 -
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL
['.•; rest -- t: ash. +�.,� �,}dei^ a (—a +.. .'>+- �4 '^.. tifi4t"'!q*• r9•^� r•-
h �
COACHELLA VALLEY WATER DISTRICT
CASH RECEIPT DETAIL ro 36663
Received From: / / o Date: — 7
Address: : �
Account No. 6412 -2 1 ` �71, 0, U Lot(s) o Tract - �-
r
Service Address G.A. Code
❑ Meter(s) $
❑ Service(s)
❑ Backflow(s)
❑
House Lateral (s) '
❑ DetectorCheck(s)
❑ Meter Surcharge
_2-15an Capacity Charge
❑ W.S.6.F.C.
r ❑ Temporary Construction Meter
❑ Turn on Charge
❑ Uncollected Account - Name
❑ Inspection Fee - Tract -
Fee - 1
❑ Plan Check Fees Water I Sewer -
' Tract -
❑ Bond°.Payment - A.D. - Bond
Assmt.
❑ Customer Deposit
❑ Other
_ TOTAL
Remarks:
❑Copy to: ,r
Cash } ► f _. r. n Water Servic
Check SZ I I 11[/ v
Mone `
y Cashier �•
Order CVWD-438(11/89)