002363 (ELEC)4 64�
P.O. BOX 1504
Building $0-720' 0WIt � LA QUINTA78-105 CCALIFORNIA 92253
Address E '
Owner
Lan&mrk r
Mailing BUILDING: TYPE CONST. 'OCC: GRP.
Address
City
%a Qubita
Contractor
Address.
Citv
Zip ITeI.
9.22M
. . Tela
A.P. Number
Legal,Description
Project Description►
State Lic.
City
& Classif. Al
Lic. #
Sq. Ft.
No. No. Dw.
'�'
Size
Stories Units
Arch., Engr.,
Designer I
New Cog Add ❑
Alter ❑ - . Repair ❑ Demolition ❑
Address
Tel.
100 emp. servim
for a ^ } ptvp n n A
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. ± j' .:� ..
r:..
r �.
SIGNATURE d i. K -1!.r[ r X ... +-. bF•---. DATE
OWNER -BUILDER DECLARATION
Estimated Valuation
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, after, improve, 'demolish, or repair any structure, prior to its issuance also
.requires the applicant for such permit to file a signed 'statement that he isaicensed 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 Professions Code, orthat. he isexemptthi'refrom, and the basis
Any Section 7031.5 'any for
Plan Chk: Dep.
.. .
for the alleged exemption. violation of by. applicant a' permit
subjects the applicant to a civil -penally of not more than five hundred dollars ($500)..
Plan Chk. Bal.
-
. 0 I, 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
Const.
Professions Code: The Contractor's 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, .lhe.building*
or improvement is sold within one year of completion, the owner -builder. will have the burden
Electrical,.
of proving that he did not build or improve for the purpose, of sale.)
❑ 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 appfy.to an owner or 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
.. C3 Lamm exempt under Sec. B. & P.C. for this reason
Driveway Enc.
Date Owner
Infrastructure
WORKERS' COMPENSATION DECLARATION
' I hereby affirm that'I have' a'ce rtificate 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. O Certified copy is hereby. furnished. . .
TOTAL.
CERTIFICATE OF EXEMPTION FROM
REMARKS
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars (S 100) valuation'
or less.) - - -
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 bf the Labor -Code, you must foehwith
comply with such provisions or this permit shalt be deemed revoked. -
..Minimum Setback Distances: '
Front Setback:frorn 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 Line
Lender's Name
Lender's Address
FINAL DATE
INSPECTOR
This is a'building permitwhen 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.
Issued by:
Date Permit
]'agree to comply with all city and county ordinances andstate laws relating to building
construction, and hereby authorize representatives -of this city to enter the above-
mentioned property for inspection purposes./ f t -
Validated by:
h,'
1 % r
Signature of applicant 0 - �_ - f r f. • Date'
Mailing Address
Validation:
City, State, Zip
.
A5.587
.5 12 225G. U .
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
SLAB GRADE
2ND FL. SO. FT.
BONDING
YARD SPKLR SYSTEM
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SO. Ff.
GAS (ROUGH)
DRAINAGE PIPING
WALL SO. Ff.
OTHER APPJEOUIP.
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, 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.
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 PLCK.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 APPJEOUIP.
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