002167 (ELEC)Building
Address . 53"'332 Oak Tree
Owner
,Avq& land
Mailing•' '
Address P.Q. � im
City Zip
'A. ��.92253-
Contractor
saat A3� and
Add
awa
0
P.O. BOX 1504 No. 002i67
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
�• BUILDING: TYPE CONST. :OCC: GRP:-
A.P. Number
Tel.
Legal Description
Project- Description
. City
pw� WISM-t
Zip. w
92260
Tel.' .
,, 568-2828,
State Lic.
City"
& Classif. 2$813o
Lic. # 328. ,
Sq. Ft.
-Size
No. No. Dw.
Stories.. Units
Arch.; Engr.,
Designer
New.9h Add ❑
Alter ❑. Repair ❑ Demolition ❑
Address
Tel.
200. � > .
City
. ..
Zip
State
Lic. #
'
. LICENSED CONTRACTOR'S DECLARATION
�+
hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of the Business andPr,Jofessions•Code, and my license is in full force and
effect = .
SIGNATURE + DATE
OWNER -BUILDER DECLARATION
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
ursuant to
the provisions of the Contractor's License Law,. Chapter 9 (commencing with Section 7000) of
th
Division 3 of e Business and 'Professions Code, or that. he is exempt: -therefrom, ind 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 tharrfive hundred dollars.($500): ' -' .
❑ I, as owner of the.property, or my employees. with wages as their sole compensation, will
Estimated Valuation
-
PERMIT "
• �AMQUNT '
Plan Chk. Dep.
-
-
Plan Chk. Bal.
COnSt.
do the work, and the structure is not intended oroffered for sale. (Sec. 7044,'Buisness and
- Professions Code: The Contractor's License Law does not apply .to an .owner of property .who
Mech.
-
builds or improves thereon and who does such work himself or. through his own employees,
. provided that' such improvements are notintendedor. offered. for sale. If, . however,.. the building
-Electrical -��
'
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.) : _
Plumbing
_
❑ 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 projectswitha contractor(s) licensed pursuant to the Contractor's License Law.).. -
O I am exempt under Sec. B. & P.C. for this reason '
S. M. 1. -
_ ..
-
Grading
'
Driveway Enc.
Date Owner
Infrastructure
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have.a certificate of consent to self-insure,tor a certificate of
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. Company
O Copy is filed,with the city. ❑ Certified copy is hereby furnished.'.
TOTAL
3-5.00
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
REMARKS.
(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
subject "to the 'Workers' Compensation provisions of the :Labor Code, you must forthwith �
comply with such provisions or this permit shall be deemed revoked.
ZONE: BY:
.Minimum Setback Distances: -
Front Setback.from Center Line
Rear Setback from.Rear Prop. Line
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construct ion•lendIng agency for the.performance of the
work for which this permit is issued. (Sec. 3097,.Civil Code.) --
Side Street Setback from.Center.Line '
Side Setback from Property Line '
Lender's Name
Lender's Address
FINAL DATE
Issued by: •
Validated by:
INSPECTOR
`Q�
Date �i Permit
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.
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 • ^ /-' - y '-f • r• Date • = �' /�*�_4
Mailing Address % °
Validation:
A.46.89
'
00 Sl
City, State, Zip
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
SLAB GRADE
2ND FL. � -- '-* SQ. FT.
BONDING
YARD SPKLR SYSTEM
POR. SQ. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SQ, FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. I SQ. FT.
GAS (ROUGH)
DRAINAGE PIPING
WALL SQ. FT.
OTHER APP./EQUIP.
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,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 ® 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./EQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ -Pius-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