001980 (ELEC)P.O. BOX 1504 No. 001980
Building 78-105 CALLE ESTADO
Address 55-640 Mk Mme LA QUINTA, CALIFORNIA 92253
Owner
BUILDING: TYPE CONST. OCC: GRP.
Mailing
Address 75-WS Cowitry Clib Drive
A.P. Number
City Zip Tel.
PaIM DoSaft 92ZO %8-2828 Legal Description
Contractor
Project Description
3i 1 mclibme arid Laid
Address .
City.. T
ip Sam Tel..
CWITIT= MI Mat=
State Lic. City
& Classif. Lic. # Sq. Ft. No. No. Dw.
_
Size Stories Units
Arch., Engr..
Designer New. Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address Tel.
City Zip State
_ .. . . I .. 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 isinfull force and
effect. ' u�"i-✓ . C
SIGNATURE DATE 4 .
OWNER-BUILDER DECLARATION
Estimated Valuation
I hereby affirm that I am exempt from the Contractor's License Law for the following yf..
reason:(Sec.. 7031.5,Business and Professions Code: Any city or county which requires a
i
permit o construct, after, improve, demolish, or repair any structure, prior. to its issuance, also - •:�
'requires the applicantlorsuch permit to file a signed, statement that be is .licensed pursuant to PERMIT AMOUNT
'
the provisions of the Contractor's License Law, Chapter. 9 (commencing with Section 7000) of,
Division 3 of the Business and' P otessions Code, or that.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.. - -
subjects'the applicant to a civil penalty of not more than five hundred dollars'($500): '• - - '
❑ I, 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 Contractors. 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. If, however, the building -
or improvement is sold within one year of completion, the owner-builder will have the burden . Electrical - 22.-%
of proving that he did not build or improve for the purpose of.sa/e.) '
❑ 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.)
❑ I am exempt under Sec. B. & P.C. -for this. reason 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
O Copy.is. filed with the city. ❑ Certified copy is hereby furnished.
TOTAL 22.50
CERTIFICATE OF EXEMPTION FROM f 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
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 Address
This is a building permit when properly filled out, signed and validated, and is subject to FINAL DATE INSPECTOR
expiration it work thereunder is suspended for 180 days. 9µtr6
I certify that.l have read this application and state that the above information is'correct. Issued. by: Date iL i7 Permit
' I agree to comply with all city and county ordinances and state'laws relating to building
construction, and hereby authorize representatives sof this city to enter the above-:
mentioned property for inspection purposes. y r Validated by:
Signature of applicant p �f ~ ' �' DaIe
Mailing Address Validation:
City, State, Zip
A3I90 1 9 2250 R
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
2ND FL.SO. FT. p
POR. SO. FT. ®
GAR. SO. FT. ®
CAR P. SQ. FT.
WALL SO. FT. ®
SQ FT @
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
BONDING
FLOOR DRAIN
MECHANICAL FEES
FORMS
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APP./EQUIP.
LAUNDRYTRAY
AIR HANDLING UNIT CFM
TEMP. POLE
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
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/a c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/4c
HOUSE SEWER
REMARKS:
VENTILATION
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE JPLCK.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 TAN{
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.
$ 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 SIGNATURESIINITIALS
GARDEN WALL FINAL