002642 (ELEC)44a
P.O. BOX 1504 No.. 002642
Building '"'r� 78-105 CALLE ESTADO
Address LA QUINTA, CALIFORNIA 92253
Owner
dim
Mailing
BUILDING: TYPE CONST. OCC: GRP.
Address 75-0055 CfR}X*-W CIdD A.P. Number
CityZip Tel.
palm Vt92260 2 Legal Description,
ContractorPM M97 Project Description per. 13 A
Address..
City - -- .Zip
Tela e
E,'D1
State Lic.
City
& Classif.
2RRIV)
Lic. #
M
Sq. Ft.
No. No. Dw.
'Size
Stories. Units
Arch., Engr.,
Designer
New W, Add ❑
Alter ❑ Repair ❑ Demolition ❑
Address
Tel.
100 wip. Qlectriad iTetE'x
City
Zip
State
- . ..
Lic: #
. LICENS..ED CONTRACTOR'S DECLgRATION
I hereby affirm that I am licensed under provisions of Chapter19 (commencing with Section
7000) of Division 3 of the Business and Professions Code, and my license is in full force and
..effect. r , .
SIGNATURE ', 3 P�a 1 -'V"' DATE
Lr"" ✓OWNER•BUILDER DECLARATION
EStlmatt d VBIUatlOfl
I hereby affirm that I am exempt from the Contractor's License Law for the following'
.
reason: (Sec. 7031.5,8usiness_ a.7d 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, licensedpursuant to
PERMIT
'
AMOUNT
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Division 3'of the'Business and Professions Code, or thabhe.is exempt therefrom, and the basis
for Any Section 7031.5 'any for
Plan.Chk. Dep:..
the alleged exemption. violation of by .applicant a permit
' subjects the applicant to a civil penalty of not more than rive hundred dollars. ($500).
Plan Chk: Bal.
-
O I, as owner of the property, or my employees with wages as their. sole compensation,'will
do the wok and the structure is not intended or offered for sale. (Sec.' 7044, Buisness and
Const.
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,
Mech.
.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
Electrical'
22.50
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-
Plumbing
struct the project. (Seo. 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 contractors) licensed pursuant to the Contractor's License Law.)
Grading
❑ 1 am exempt under Sec. B. & P.C. for this reason
Driveway Enc.
Date Owner
Infrastructure
WORKERS' COMPENSATION DECLARATION
I 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.)
Policy No. Company
O Copy is filed with the.city.. ❑ Certified copy.is hereby furnished.
TOTAL
22.50
CERTIFICATE OF EXEMPTION FROM
REMARKS
WORKERS' COMPENSATION INSURANCE I
(This section need not be completed if the permit is ' for one hundred dollars ($100) valuation
--orless.) - -
I certify that in the performance of thg work for which this permit is issued, I shall not
-
-employ any person 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
ZONE:
BY:, '
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
Minimum Setback Distances:
'
comply with such provisions or this permit shall be deemed revoked. -
Front Setback from Center Line
.
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY
Side Street Setback from Center Llne
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.) -
Side Setback from Property Line,
Lender's Name
Lenders 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
d 1.7 Permit
certify that I have read this application and state that the above information is correct.
ISSued'by:
Date
I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authcrize representatives of this city to 'enter the above-.-
bove-.mentioned
mentionedproperty for inspection purposes.
Validated by:
Signature of applicant .. rr.-' :'�-. r 'F .t. Date P
_+r�,
Mailing Address `-'� -
Validation:
City, State, Zip
A 6 5 1 4-
10 13 2256 ik
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
SLAB GRADE
2ND FL. SQ. FT. ®'
BONDING
YARD SPKLR SYSTEM
POR. SQ. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CARP. SQ. FT.
GAS (ROUGH)
DRAINAGE PIPING
WALL SQ. FT.
OTHER APP./EQUIP.
DRINKING FOUNTAIN
SQ FT ®
TEMP. POLE
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GROUT
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SYSTEM
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L 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.
SO. FT. ® c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID a 11/4 c
SEWAGE DISPOSAL
GAR. FIREWALL
SO.FT.GAR ® 3/4c
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 OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP./EQUIP.
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 SIGNATURESIINITIALS
GARDEN WALL FINAL