002360 (ELEC)Building 38 O% M ,
Address a
Owner
mid
Mailing
Address 1fr
City - - Zip
. Lat o ... 92253
Contractor
SEM
.Address. .
Sam
City Zip
FTTeI
Tela
44'
P.O. BOX 1504 No. aa�a
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
BUILDING: TYPE CONST, OCC: GRP.
A.P. Number
Legal Description
Project Description
State Lic.
City
• & Classif. MISM
Lic. #
Sq. Ft.
No. No. Dw.
Size - - -
Stories Units
:. Arch.,'Engr.,
Designer
New ❑ Add ❑
Alter ❑ Repair ❑ Demolition ❑
Address
Tel.
100 a=. smy bw mg. Lv%1s=e/1i
City
Zip
State
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. _ �. -,e f ." .p• /.
..
SIGNATURE v Y.- ' .' ' _ r ,+c' DATE .
" T 'OWNER -BUILDER DECLARATION '
' I hereby affirm that I am exempt from the Contractors' License L.aw'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
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section. .7000) of
' Division' 3 �of the Business and Professions' Code, or thathe' is exempt therefrom, 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 ofnot more than five. hundred dollars ($500).
O 1, as,owner of the property, or my employees.wilh wages as their sole compensation, will
" do.the work, and the structure is not intended or offered for sale. (Sec. 7044; Buisness and
Professions Code: The Contractor's, License Law does not apply to. an owner of property who
Estimated Valuation
-�
-
PERMIT
- '
AMOUNT
Plan Chk. Dep.
.• -
Plan Chk.. Bal..
_
Const..
Mech.
.
builds or improves thereon and who does such work himself or through his own employees,
provided that such improvements are not intended or offered for sale. If, however, the. building.
'Electrical'
.
yy g
22 s � 0
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
..
O 1, as owner of the property, am exclusively contracting with licensed contractors to conn.
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. ti P.0 -for this reason
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
fWorker'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;1-50
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 tha 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
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.Llne
Lender's Name
FINAL DATE
-INSPECTOR
Lenders Address
This is a building'permit when properly filled out,.signed and validated, and is'subjecl to
expiration if work thereunder is suspended for 180 days.
I certify that I have read this application and state'th'at the above information is correct.
agree to comply with all city and' county ordinances and stale laws relating.lo',building
construction, and hereby authorize representativesof• this city to enter the above=:
property for inspection purposes- s" r '
. , . (�i, f1 r , � .�,`-
Signature of applicant •' r1 -� € ' {-.+�lf.'aF;w Dater
Mailing Address
Issued by:
Validated by:
Validation:
A5591
T
Date Permit
-
5 1.2. 225 G CK
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. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SO. 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.000L HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
FINAL INSP.
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
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.
SO. FT. ® c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. 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
ROCKSTORAGE
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
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS.
GARDEN WALL FINAL