002365 (ELEC)44
P.O. BOX 1504 NQ., 002365
Building 78-105 CALLE ESTADO
Address 55-1.5). CMk TrM` ' LA QUINTA, CALIFORNIA 92253
Owner
Mailing
BUILDING: TYPE CONST. OCC: GRP: -
Address pnot 1060 A.P. Number
City Zip Tel.
..- ...r quinta . 92253 Legal Description
Contractor Project Description PM IRM
Address
Sam
City Zip . Tel:
State Lic. City
& Classif. Lic. # Sq. Ft. No. No. Dw.
Arch:, fngr., .. .. ...
Size Stories Units
'. Designer New EX Add ❑ Alter ❑' Repair ❑ Demolition ❑
Address Tel.
City Zip State 100 am. =V. for a sump p in Tftam 1 A
o. 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 Professions Code, and *my license is in'full force and
effect.
SIGNATURE DATE _
OWNER -BUILDER. DECLARATION Estimated Valuation
I hereby affirm that I am exempt from the Contractor's License Law for the following
reasom.(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 '' - AMOUNT
requires.:the applicant for such permit to file a signed statement that he is licensed pursuant to PERMIT - - -
the provisions of the Contractor's License Law, Chapter.9 (commencing with Section. 7000) of
Division '3 of the Business and Piofessidns Code, or'.thaf. he 'is exempt therefrom, 'and the basis
for the alleged exemption. Any violation of Section 7031.5 'by any- applicant for a permit Plan'-Chk. Dep. r
-subjects the applicant toe civil penalty or not .more 'than five hundred dollars ($500).
ow ; 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 COnSt..
'Professions Code: The Contractor's License Law does not applyto 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 or completion, the owner-builder.will have. -the burden �ry - 'EIBCtrICdl +raa
of proving that he did not build or improve for the purpose of sale.) -
50
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con Plumbing
struct the project. (Sec. 7044, Business wand 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.).
Grading
❑ 1 am exempt under Sec. B: & P.C. for this reason
Driveway Enc.
Date owner Infrastructure
WORKERS' COMPENSATION DECLARATION
hereby`sffirm 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
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.). .. .. ._
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 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 it work thereunder is suspended for 180 days.
I certify that I have read this application and state that the above information is correct. Issued by: Data Permit
1 agree to comply with all city and county ordinances and state laws relating' to building . i -
construction, and hereby authorize representatives sof this city to- enter •the above-.
mentioned property for inspection purposes. Validated by:
Signature of applicant Date -
Mailing Address Validation:
City, State, Zip
A5586 5 12 2250 U
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SQ. 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 APPJEQUIP.
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.COOL HOOD
SIGN
WASH ER(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.
SQ. FT. ® c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1114 c
SEWAGE DISPOSAL
GAR. FIREWALL
SQ.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 APPJEQUIP.
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
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIG NATU RESIN ITIALS.
GARDEN WALL FINAL