001951 (ELEC)Building
Address
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
Mailing
Address 75-.00 j (bMtXy Clbb ' jkiW
City Zip Tel.
palm Deft 32264 568-2328
Contractor
Address. .. .
..City . Sam
I
State Lic.
& Classif.
Arch., Engr., '
Designer
Address
Tela
Sam -SIMM
No. L101951
BUILDING: TYPE -CONST:_ - OCC.-GRP.-
A.P.
CC:GRP.•
A.P. Number
Legal Description
Project Description
Lic. # Sq. Ft. No. No. Dw.
Size Stories Units
Tel.
New p Add ❑ Alter ❑' Repair ❑ Demolition ❑
City Zip State A total of. 23 O
Lic. # ...
_ LICENSED CONTRACTOR'S DECLARATION mtkavid p0g.
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section'
7000) ofDivision 3 of the Business and Profess ions•.Code, and my license is in full force and
effecty. ./. . . . .
SIGNATURE 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 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, licensed pursuant to • PERMIT
the provisions of the Contractor's License Law, Chapter.9 (commencing with Section 7000) of
Division3.of the *Business and Professions Code; or that. he is exempt theiefrom, 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 five hundred dollars ($500):
O I, as owner of the property, or my employees with, wages as their sole compensation, will
w
do the ork, and the structure is not intended proffered for sale. (Sec. 7044, Buisness and
Professlons 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 lhrough�his own employees,
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
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-
• 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
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
❑ I am.exempt under Sec. B. & P.C. for this reason
Plan Chk: Dep. .
.Plan .Chk. Bal.
Const.
Mech..' .
Electrical '
Plumbing
S.M.I.
Grading
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
• 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., U, 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 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.
Signature of applicant ' Date
Mailing Address x '
City, State, Zip
HARD COPY
Rear Setback from. Rear Prop. Line
r
'AMOUNT
135.00
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE INSPECTOR
Issued by: Date 12" 12-85Permit
Validated by:
Validation:
A 3 5 3 Sl
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. ® $
UNITS
SLAB GRADE
2ND FL. SO. FT.
BONDING
YARD SPKLR SYSTEM
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SQ. FT.
GAS (ROUGH)
DRAINAGE PIPING
WALL SQ. 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.000L 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.
SQ. FT. ® c
BATH TUB
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1+/4 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 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
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATUR=S/INITIALS,
GARDEN WALL FINAL