15117 (ELEC).414
' P.O. BOX 1504 15
1.17
Building 78-495 CALLE TAMPICO
Address 55-493 RIVIERA DR LA QUINTA, CALIFORNIA 92253
ownerGARY me CUR
Address SAW.
City p Tel.
. Zi92253
Contractor
SOUT=- ST ELECT
Addres
17--582 COUNTRY CULL f-2
City PALM DESSM'Zlp3221i T21160.^18 6
State Lic.. City
& Classift_! Lic. it 2865
-Arch., Engr.,
Designer
Address Tel.
cityJZip State
. Lic. #
'K/ LICENSED CONTRACTOR'S DECLARATION
`I herebyy affirm that I amilicensed under provisions of Chapter (commencing with Section
7000) of Di`viision 3 of the�pusines fanndpofdssions Code,, and my license is in.full.force and
OWNER -BUILDER DECLARATION'
,rte"' 1 herebyeaffign 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 whichrequires 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 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..that. he is exempt therefrom, and the basis
for the alleged exemption. Any vhlaWn 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).
❑ 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
Professions Code: The Contractor's License Law does not appy 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 bund or improve for the purpose of sale.)
❑ I. 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)Qcensedpursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec B. & P.C. for this reason
Date Owner
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 the_reof..(Sec. 3800, Labor Code.)
Policy No. Company '
O Copy is filed with the city, . ❑ 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.)
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: ft, 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.
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION.COVERAGE IS UNLAWFUL, 'AND
SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP. TO ONE
HUNDRED THOUSAND DOLLARS ($100,000)„IN ADDITION TO THE COST OF COMPENSATION,
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE; INTEREST, AND
ATTORNEY'S FEES.
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.
I certify that I have read this application and state that the above information is correct.
I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives of this city. to enter the above—
mentioned property for inspection purposes.
Signature of applicant Date'
Mailing, Address
City, State, Zip
BUILDING: TYPE CONST. - - OCC: GRP.
A.P. Number
,Legal Description
Project Description 17 light fixtures
Sq. Ft. No. No. Dw.
Size• • . Stories Units,
New ❑ Add ❑ ' . Alter ❑ Repair ❑- Demolition ❑
Estimated Valuation 2DOO
PERMIT
AMOUNT -
Plan Chk. Dep.
Plan Chk. Bal.
Const.
30. 0 Q
Mech.
Electrical '
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
30.00
REMARKS
ZONE: BY'
Minimum Setback. Distances:
Front Setback from Cent r Line
Rear Setback from Re ff3 � Line
Side Street Setbac �Cen r Line
Side Setback fro opertt.
FINAL DATE / INS
Issued by: at .ermit
Validated by:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING; FEES
1ST FL. SQ. FT. ® $
2ND FL. SO. FT.
POR SQ FT ®
GAR. SO. FT. ®
CAR P. SQ. FT.
WALL SO. FT.
SO. 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
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
.GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER'APPJEOUIP.
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.
SO. FT. ® c
BATH TUB
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID-® 114 c
SEWAGE DISPOSAL
SO.FT.GAR Q 3yac
HOUSE SEWER
REMARKS:
VENTILATION
GAS PIPING
PERMIT FEE
PERMIT FEE.
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE ELECT. F.EE'
SMI FEE PLUMB. FEE.
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
GROUND PLUMBING
UNDERGROUND
eA.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'APPJEOUIP.
REINF. STEEL'
GAS (FINAL) '
TEMP. POLE
GROUT
WATER HEATER
SERVICE
SFINAL 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
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL