002358 (ELEC)P.O. BOX 1504 No. 002358
Building 78-105 CALLE ESTADO
Address -095 call, rltm LA QUINTA, CALIFORNIA 92253 '
Owner
BUILDING: TYPE CONST: OCC: GRP.
'Mailing '
Address P 0- A.P. Number
City Zip Tel.
Ta
� 92253Legal Description
Contractor
• .- - Project Description
.Address ..
City Zip Tela
F
State Lic. City
& Classif.�,Lic. #�� Sq. Ft. No. No. Dw.
..
Size -Stories Units
Arch., Engr.;
Designer New R_ Add ❑ Alter ❑. Repair ❑ Demolition ❑
Address Tel.
CityZip State
100 c . � /liqhtiM
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 Prof essions,Code,,,and•my license is'in fulHorce and
effect. , � ff .j� .
SIGNATURE y DATE . , . - - - - • , _
OWNER -BUILDER DECLARATION Estlrllated Valuation
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, after, Improve, demolish, or. repair any structure, prior to its issuance also
requires the applicanlzfor such permit to file a signed statement that he•is licensed pursuant 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 that. he 'is exempttherefrom, and the !iasis •- ,
for the alleged exemption. Any violation of Section 703105. by 'anyapplicant for -a permit Plan.Chk. Dep.
subjects the applicant to a civil penalty of not more than five hundred' dollars ($500).- -- -
. - ❑ I, as owner of the property, or my employees with wages as their sole compensation, will - Plan Chk.'Bal.
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and COr1St.
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, .Mach.
,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 - 22y
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. (Seca. 7044, Business -and Professions Code: The' Contractor's License Law
does not apply town owner or 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.)
Grading
1 am exempt under Sec. B. & P.C. for this reason
Driveway Enc.
Date owner 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 22.50
CERTIFICATE OF EXEMPTION FROM REMARKS
WORKERS' COMPENSATION INSURANCE
(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 the 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 Line,
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
Lender's Address FINAL DATE INSPECTOR
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: - .JU�
I certify that I have read this application and state that the above, information is correct. Issued by: Date' •J'- fJ 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 inspectiorrburposes: p f Validated by:
Signature of applicant I *-< : ? ..*�' v .r -+ €.N Date
Mailing Address Validation:
City, State, Zip
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
SLAB GRADE
2ND FL. SO. FT.
BONDING
YARD SPKLR SYSTEM
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SO. FT.
GAS (ROUGH)
DRAINAGE PIPING
WALL SO. FT. ®
OTHER APPJEOUIP.
DRINKING FOUNTAIN
SO. 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.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FINAL INSP.
GARBAGE DISPOSAL.
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
KITCHEN SINK
ABSORPTION SYSTEM. B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET'
COMPRESSOR HP
POLE,TEMIPERM
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
GAR. FIREWALL
SO.FT.GAR ® 3Ac
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 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 SIGNATURESIINITIALS
GARDEN WALL FINAL
p