002330 (ELEC)P.O. BOX 1504
Building 78-105 CALLE ESTADO
Address 55-2.00 Oak Niu LA QUINTA, CALIFORNIA 92253
Owner
Mailing
Address. 75-005 Cbmitry Club Dr;
City Date
ft JZip Tel. 568-2828
alM
. 92260
Contractor
Address
City ;T
State Lie.
& Classif. 29*130
Arch., Engr.;
Designer
Address
Tel.
I Lie. # 32
; I Tel.
No. 002330
BUILDING: TYPE CONST: OCC: GRP.,
A.P. Number
,Legal Description
Project Description
Sq. Ft. No. No. Dw.
Size - Stories Units
New 0Add ❑ Alter ❑ Repair ❑ Demolition' ❑
Date Owner
WORKERS' COMPENSATION DECLARATION
Thereby affirm* that'I have a* certificate ofi 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.
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 thg work for which this permit is issued, I shall not
-employany person in any manner so as to become subject. to the Workers' Compensation'
Laws of California-
'Date—_L_
alifornia'Date L_ ' Owner
NOTICE TO APPLICANT:, ff, 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
1 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 it work thereunder is suspended for 180 days.
I cartify.that.l have read this application and stale that the above information is correct. ..
I agree to comply with all city" and county ordinances and stale laws relating to building
construction, and hereby authorize representatives -of this city to enter the above-.
mentioned property for inspection purposes.
t
Signature of applicant Date
Mailing Address 5
City, State, Zip
HARD COPY
n ras ruc ure
TOTAL 35.00
REMARKS
ZONE:
BY:
,
City
Zip
State
Rear Setback from Rear. Prop. Line
Lie. #
_ LICENSED CONTRACTOR'S DECLARATION
41 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. - . . . . . . . ..
a r .
d '
INSPECTOR
SIGNATURE f S - - DATE,-
' OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractors License Law for the following
reason(Sec. 7031.S,Busfness and Professions Code: Any.city,or county which requires a
Estimated Valuation
Fps
V
_
PERMIT AMOUNT
permit td� construct, --after, improve, demolish, or repair any structure, prior to its issuance also
requires the applicant for such permit to rite 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 thatdie is'exenipt 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 frve'hundred'dollars ($500). '• -
0. 1, as owner of the property, or my employees with wages as their sole compensation, will
-
Plan CW Dep. .
Plan Chk. Bal.
COnSt.
do the work, and the structure is not intended ot.offered for sale. (Sec. 7044; Sitisness and
Professions Code: The Contractor's License Law does not apply to an owner of property who
-such
Mech.
builds or.improves thereon and who does work himself or through his own employees,
provided that' such improvements are not intended or offered for sale. If, however, the building
Electrical - 35.00
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.) .' ...
Plumbing
O 1, 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 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.) -
❑ 1. am exempt under Sec. B. & P.C. for this reason -
Grading
Driveway Enc.
I f t t
Date Owner
WORKERS' COMPENSATION DECLARATION
Thereby affirm* that'I have a* certificate ofi 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.
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 thg work for which this permit is issued, I shall not
-employany person in any manner so as to become subject. to the Workers' Compensation'
Laws of California-
'Date—_L_
alifornia'Date L_ ' Owner
NOTICE TO APPLICANT:, ff, 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
1 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 it work thereunder is suspended for 180 days.
I cartify.that.l have read this application and stale that the above information is correct. ..
I agree to comply with all city" and county ordinances and stale laws relating to building
construction, and hereby authorize representatives -of this city to enter the above-.
mentioned property for inspection purposes.
t
Signature of applicant Date
Mailing Address 5
City, State, Zip
HARD COPY
n ras ruc ure
TOTAL 35.00
REMARKS
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
Permit
Issued by:
Date
Validated by:
Validation:
A 5 3 3 3
4 21 3500 9
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
2ND FL. SQ. FT.
POR. SQ. FT. ®
GAR. SQ. FT. ®
CARP. SQ. FT.
WALL SQ. FT.
SQ. 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 APPJEQUIP.
LAUNDRYTRAY
AIR HANDLING UNIT CFM
TEMP. POL
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
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
ROCKSTORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POL
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
FINAL INSP.
GRADING
cu. yd.
$ -Plus-X$-=$
LUMBER GR.
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