002163 (ELEC)P.O. BOX 1504 :NO. 002163'
Building 78-105 CALLE ESTADO
Address 80--732 Onk Tree LA QUINTA, CALIFORNIA 92253
Owner r
BUILDING: TYPE CONST. OCC: GRP.
Mailing
Address ';a -WS Oxaitry ClUb D--. A.P. Number .
City Zip Tel.
Palm Dmmft 92260 568-21.25 Legal Description
Contractor Project Description tea.
MU Atc. m3 Lmd_
Address
amgtgw
'City . Zip Tel.._
Sam
State Lic. City
& Classif. 288nO Lic. # 328 Sq. Ft.
Arch., fngr.; •" - -
Size
Designer New Q' Add ❑ Alter ❑ Repair ❑
Address Tel.
City Zip State Me 2M a
. . . . . . Lic. # .
LICENSED CONTRACTOR'S DECLARATION
1 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.. / , 'r .:. . _ � :A Is'
No. No. Dw.
Stories Units
4. f.✓�-Y�3..
Demolition ❑
Date Owner
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,. prion 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) or
Division 3 of the Business and Professions 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
subjects the applicant to a civil penalty of not more than five hundred dollars ($500).'- '
❑ 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
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,
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 orimprove 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 a contractor(s) licensed pursuant to the Contractor's License Law.)
❑ I am exempt under Sec. B. ti P.C. for this reason
Estimated Valuation
y
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
.PERMIT.
AMOUNT
'
..
Plan -Chk. Dep.. ••
-
Plan Chk. Bal.
Const.
CONSTRUCTION LENDING AGENCY
Mech'.
Side Street Setback from Center.Line
Electricals
�.�Q
Plumbing
work for which this permit is issued. (Sec. 3097, Civil Code.)
S. M. 1.
Side Setback from Property Line
Grading
Driveway Enc.
Lender's Address
Date Owner
Infrastructure
' This is a building permit when properly filled out, signed and validated,'and is subject to
WORKERS' COMPENSATION DECLARATION
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. O Certified copy is hereby furnished.'
• CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($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.
J`it�
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'
TOTAL
75.00
REMARKS
mentioned property for in purposes.
Validated by:
Signature of applicant Date
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
FINAL DATE
INSPECTOR
' This is a building permit when properly filled out, signed and validated,'and is subject to
expiration it work thereunder is suspended for 180 days.
I certify that I have
J`it�
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 representatives eof this city to enter the above-.
mentioned property for in purposes.
Validated by:
Signature of applicant Date
Mailing Address
Validation:
City, State, Zip
A 4b53.
3 1_l. %506 Sl
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SQ. FT. ® $
UNITS
SLAB GRADE
2ND FL. SQ. FT.
BONDING
YARD SPKLR SYSTEM
FOR. SQ. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SQ. FT.
GAS (ROUGH)
DRAINAGE PIPING
WALL SQ. FT.
OTHER APPJEOUIP.
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
IKITCHEN 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
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 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
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIIN(TIALS,
GARDEN WALL FINAL