PLBG (9685)Building
Address- 52-970 NAV'ARRO
Owner
MARIO 1. JUAREZ
Mailing
Address SAME
City Zip
15 KIELEY RD
6u
P.O. BOX 1504 , N o .
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
State Lic. City
& Classjf. 256194—A . , Lic. # 196
Arch., Engr.,
Designer _
Address Tel.
Zip (State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed undeF Drovisions of Chapter 9 (commencing with Section
•-� 7009))tof /Diviswn ot�th7e�BusAss anS P.Mfessions Code, and my license is in full force and
efdrl V/ / rtaz ✓ 4' 7 r
SIGNAT RE_ + 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, atter, 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 penalty of not more than rive hundred dollars ($500).
❑ 1; 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
y 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, 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 buildsor improves thereon, and who contracts for
such projects with a contractors) licensed pursuant to the Contractor's License Law.)
O 1 am exempt under Sec. B. & P.C. for this reason
Date Owner
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 certitiAd copy tthereeef.hSec&800, Labor Code.)
Poli o. Company •i dd UUJONILL
MO -y is filed with the city. ❑ Certified copy is hereby furnished.
/ CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed it the permit is for one hundred dollars ($100) 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 ubject to he Workers' Compensation
Laws oyC tfornia f /e!
Date 4 2� Owner �j �J�'! -
NOTICE -TO APPLICANT: If,faker 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
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.)
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 -of this city to enter the above-.
mentioned property for Inspection purposes.
Signature of applicant Date
Mailing Address
City, State, Zip
BUILDING: TYPECONST. SEWER `UCC"CR�P.
9685
A.P. Number
Legal Description
Project Description
f
SEWER € OOKUP
Sq. Ft.
Size
No. No. Dw.
Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
$1900 0
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
$3 . uu
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
• UU
REMARKS
• rt .^1 6 � f�
10
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE INSPECTOR
Issued by: Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. ® $
2ND FL. SO. FT.
POR. SO. FT. ®
GAR. SO. Fr. ®
CAR P. SO. FT.
WALL SO. FT. ®
SO. FT ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
i
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.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APPJEGUIP.
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.
SO. FT. ® c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
�
SO.FT.GAR ® 3/ac
HOUSE SEWER
VENTILATION
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 APPJEGUIP.
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
6
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
I
CO4CHELLA VALLEY• WATER DISTRICT
331980
CASH RECEIPT, DETAIL
r p o
Date, a aJ ! % '
Received From:
J �✓ll Y1 Q
w� ✓V1 :+
� � Tract
s �'
Address:
No.�b I, -:x` U � �
D • V Lot(s)
G.A. Code
Account
mea -
61 f'. r "O
I ~'
Service Address
$
❑ meter(s)
❑ Service(s)
❑ Backflow(s)
I" '
❑ House Lateral(s)
❑ DetectorCheck(s)
1 S?S• oo � �;.
❑ Meter Surcharge
V anitatloncapacit�yCharge
❑ W.S.B.F.C.
❑ Temporary Construction Meter
❑ Turn on Charge
❑ Uncollected Account - Name
I
O Inspection Fee - Tract -
j
Fee -
I
j
❑ Plan Check Fees Water I Sewer -
'
I
Tract -
❑ Bond Payment - A.D. Bond__-
Assmt.
fII
❑ Customer Deposit
f
❑ Other
is"• w
TOTAL
$
1�N1\ r1(1
Remarks:
❑Copy to
WeterSeryice
Cash_
Check
a ti:,,.'}
�;
�•,
-ashler
(11199) I
Money
CVWD-438
Order