002364 (ELEC)4
P.O. BOX 1504 No 002364
Building 54"73. v t� . 78-105 CALLE ESTADO
Address LA QUINTA, CALIFORNIA 92253
Owner
l2mdWMk
Mailing,
BUILDING: TYPE CONST. OCC: GRP..
Address P.O. 'B= low A.P. Number
CityZip Tel.
L. �vi� Legal Description
Contractor Project Description
Address ... .
��rfss
.City Zip. Tela.
State Lic. City
& Classif.. Lic: # Sq. Ft. No. No. Dw.
.... Arch., Engr.; _ ..
Size Stories Units
.Designer New EIX Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address Tel.
City Zip State am. sm. for a mm rt= in Phase 2 A
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of'Chaptei 9 (commencing'with Section
7000) of Division 3 of the Business and Professions Code; and myrlicehse is in'full force antl
effect. ..
SIGNATURE x w.;' DATE .,
OWNER -BUILDER DECLARATION Estimated Valuation
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 orcounty which requires' a
permit to construct, alter, improve, demolish, or repair any structure, prior lo'its issuance also AMOUNT
req fres the applicant for such permit to file a signed statement that he is.lfcensed pursuant to PERMIT
the provisions o/ the Contractor's License Law,.Chapter. 9 (commencing with Section .7000) of -
Division Xof*the Business and'Pro/essions Code, or tha6•hesis exempt therefrom, anis the basis '
for the alleged exemption. Any -violation of Section 7031.5 by 'any applicant for a permit Plan Chk, Dep::
•" - subjects the applicant to a civil penalty of•not more than'five hundred dollars'($500).
❑ 1, as owner of the, property, or my employees with wages as their sole compensation, will Plan Chk. Bal.
do the woik, and the structure is not intended Const.or offered for sale. (Sec. 7044, Buisness and Cost. .
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. I/, however, the building ..-
or improvement is sold within one year of completion, the owner -builder will have the burden Electrical
o/ proving that he did not build or improve for -the purpose o/ sale.) _
❑ 1, as owner of the property, am exclusively contracting .with licensed contractors to con- Plumbing
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.
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
hereby affirm that I have a'oertificate'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. O 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
CONSTRUCTION LENDING AGENCY
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.)
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: �' f
Signature of applicant? '- ret Date
Mailing Address
City, State, Zip
HARD COPY
Rear Setback from Rear Prop. Line
Side Street Setback from. Center Line
Side Setback from Property Line
FINAL DATE INSPECTOR-
Issued
NSPECTORIssued by: Date` Permit
Validated by:
Validation:
A 5 5 8 5 5 12 2250 C.k
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. @ $
UNITS
SLAB GRADE
2 ND FL. SO. FT. @
BONDING
YARD SPKLR SYSTEM
FOR. 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 APP./EOUIP.
DRINKING FOUNTAIN
SO FT @
TEMP. POLE
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GROUT
WATER PIPING
NOTE: Not to be used as properly 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, 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
GAR. FIREWALL
SO.FT.GAR @ 3/ac
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./EOUIP.
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 SIGNATURESANITIALS
GARDEN WALL FINAL