002361 (ELEC)Building 8"'540 0A
Address IRMO
Owner
Landmak LWA
Mailing
Address P,.0. Tinx 11100
City Zip
La Quinta L 92M
Contractor
Sam
Address . . .
Sam
City JZio Tel.
PZ?"MI6
State Lic.
& Classif. ' 413636
Arch.;-Engr., '
' Designer
Address
44
P.O. BOX 1504 No. 00'2361
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
ILic'. # 133
Tel.
BUILDING: TYPE CONST. OCC:'GRP.-
A.P. Number
Legal Description
Project Description
Sq. Ft. No. No. Dw.
Size - - Stories Units
New {� : Add ❑ Alter ❑ Repair ❑
Demolition ❑
WORKERS' COMPENSATION DECLARATION
100 mp. GIV.
% pw. lindsony-0014gh-tim
City
Zip
State
L-ic. #
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
LICENSED CONTRACTOR'S DECLARATION
I hereby, l
affirm that I am icensedunder provisions,iif Chapter 9 (commencing with Section
7000) of Division 3 of the Business and Professions. Code, and my,license is in full force and
effect...
Policy No. .Company
SIGNATURE if - ✓�.-`- DATE
OWNER -BUILDER DECLARATION
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•.whkh-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 o/ the Business and Professions Code, or that. he is exempt. therefrom, and the basis :. for
the alleged exemption. Any violation o/ Section 7031.5. by 'any -applicant fora permit
' subjects the applicant'to a civil penalty of not more than rive hundred dollars ($500).
O 1,'as owner of the. property,, or my employees with wages as their sole compensation, will.
do the work, and the structure is not intended or offered. for sale. (Sec. 7044, Buisness=and
Pro/essions Code: The Contractor's License Law does not apply to an owner of property who
builds or Improves thereon and who does -such workhimself or through 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.)
❑ 1, 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 acontractor(s) licensed pursuant to the Contractor's License Law.)-
. ❑ 1 am exempt under Sec. B. & P.C. -for. this reason
Estimated. VallfatlOn
_/�
_ PERMIT
- - -
AMOUNT
Plan Chk.'Dep..
-
Plan.Chk. Bal.
..WORKERS' COMPENSATION INSURANCE
COnSt.
McCh.
EIBCtrICal
`�� 50
Plumbing
'
S.M,I.
Grading
employ any person in any manner so as to'become subject to the Workers' Compensation
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:rJ
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.
' Date Owner
NOTICE TO APPLICANT: It, after making this Certificate o/ 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,fTom 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,;CivilCode.), ., _ _
Side Setback from Property Line
Lender's Name
Lender's Address
FINAL 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.
5-8-86
I certify that I have read this application and state that.the above information is correct.
Issued by:
Date Permit
I agree to comply with all city and county ordinances and state' laws `relating'•to building
construction, and hereby authorize representativesp6f- this city.,to enter the above-.
mentioned property for inspection purposes.! f r =
Validated by:
. �,,. .
Signature of applicant ' •t • f.. •'� r a' a ... 'Date
Mailing Address
Validation:
City, State, Zip
A5590
5 12 225 Ck
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
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.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, 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.
SQ. 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 JELECT.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.
$ 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/I VITIALS,
GARDEN WALL FINAL