002162 (ELEC)P.O. BOX 1504 No. 002162
Building 78-105 CALLE ESTADO
Address 55 32.9 � LA QUINTA, CALIFORNIA 92253
Mailing
Address 75-4
City
i
Contractor
Address
City -
sam
State Lic.
& Classif. 28€
Arch., Engr., "
Designer -
Address
Zip Tel.
322,60
tgage ..$
BUILDING: TYPE CONST: OCC: GRP.:
A:P. Number
M Legal Description
28
Project Description Film,
Tela
City
Lic. # 328
Tel. 3
SO. Ft.
Size -
New R- Add ❑
No.
Stories
Alter ❑
No. Dw.
Units
Repair ❑ Demolition ❑
City Zip State 109 iv, n4mo —a area % "
C. IF ...
.$ LICENSED CONTRACTOR'S DECLARATION, .
I hereby affirm that I am licensed under provisions of'Chapter 9 (commencing with Section
70 01)
00) of Division 3,of%the Business and Professions Code; and my license is in full force a d,
ect. /
SIGNATURE DATE ..
r ' OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's Licensd'Law for the following Estimated Valuation
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—
- AMOUNT
It the provisions of the Contractor's License Law, Chapter 9 (commencing with Section .7000) of
c
Z.sion'3 of the Business and Piofessions Code, or thathe'is.exempt therefrom, and the basis -
for the Any Section 7031.5 - 'any. for
plan.Chk. De p
-
alleged exemption. violation of by applicant. a permit
subjects the applicant'to a civil penalty of not -more than five hundred dollars ($500).
Plan Chk. Bal.
-
. ❑ I, as.owner of. the property, ormyemployees with wages as their sole compensation, will
.
do the work, avid the structure is not intended or offered for sale. (Sec. 7044, Buisness and
*not
Const.
Professions Code: The Contractor's License Law does 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. It, however, the, building
or improvement is.sold within one year of completion, the owner -builder will have the burden
- EI2CtrICal
-��
of proving that he did not build or improve for the purpose of sale.). _ '
0 I, 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,M-I. . .
• such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) -
Grading
0 I. am exempt under Sec. B: & P.C. •for this reason
Driveway Enc.
Dale 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 it 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
employ any person in any manner so as to become subject to the Workers' Compensation
Laws of California.
NOTICE TO APPLICANT: It, after making this Certificate of Exemption you should become -
ZONE:
BY'
subject to the' Workers' Compensation provisions oftheLabor Code, -you must forthwith
comply with such provisions or this permit shall be deemed revoked.
_ Minimum Setback
Distances:
Front Setback'from Center.Line
Rear Setback from Rear. Prop. Line
CONSTRUCTION LENDING AGENCY
Side Street Setback from Center Line
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.)
-
Side Setback from Property Line
Lender's Name
Lender's AddlessFINAL
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.
I certify that I have
1�� Permit
read this application and state that the above information is correct.
Issued by:
Date
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. ,.
Validated by:
Mme:
Signature of applicant -1t t '` ' e^ rt �.+� . I'Date /
Mailing Address
Validation:
City,' State, Zip
A4b94
3 11 2250 Sl
HARD COPY
or CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SQ. FT. ® $
UNITS
SLAB GRADE
2ND FL. SQ. FT.
BONDING
YARD SPKLR SYSTEM
POR: SQ. FT. p
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SQ. FT.
GAS (ROUGH)
DRAINAGE PIPING
WALL SQ. 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
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.
SQ. FT. ®c
BATH TUB
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 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 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
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL