15760 (ELEC) IIIIIII VIII III VIII IIII 46
IE 4
P.O. BOX 1504 No. 15750
Buildin78-495Addrress 49-578 Avila LA QUINTACCALIFORNIA 92253 �
Owner Chas Bii.lmin `
Mailing BUILDING: TYPE CONST. OCC.GRP.
Address 49-578-"Avila A.P.Number
City Zip Tel.
La Quinti: 92253 Legal Description
Contractor �� Lighting �' �'C � C Project Description " Change exist 126amp t6. 2f�0t p
Address Electrical Service
39- 784 Roo ipauch
City Zip Tel.:
eiscula 9259-. (919) 676--1688
State Lic. � � City
&Classif. 08 Lic.#NeW App• Sq.Ft. No. No. Dw.
Arch., Engr., Size Stories Units
Designer. New ❑ Add ❑ Alter❑ Repair❑ Demolition ❑
Address Tel.
City Zip State
Lic.#
LICENSED CONTRACTOR'S DECLARATION y
Irhereb-affirm that I;am,licensed under provisions of Chapter 9(commencing with Section
of Division 3 of the;Business and Professions_Code,and my license is in full force and
} effect. t .r.^ $ �,_�..«• ..�
�SIGNATIIRE E DATE
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following Estimated Valuation `60 00
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a W
permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance also
requires the applicant for such permit to rile a signed statement that he is licensed pursuant to PERMIT AMOUNT
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Division 3 or 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 Plan Chk. Dep.
subjects the applicant to a civil penalty of not more than rive hundred dollars($500).
❑I,as owner of the property,or my employees with wages as their sole compensation,will Plan Chk. Bal.
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, the building
or improvement is sold within.one year of completion, the owner-builder will have the burden Electrical t'� •
of proving that he did not build or improve for the purpose of sale.)
01,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 apply to an,owner of property*who builds or Improves thereon, and who contracts for S.M.I.
such projects with contractors)licensed pursuant to the Contractor's License Law.)
Grading
O 1 am exempt under Sec B.&P.C.for this reason
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
O Copy is filed with the city. O Certified copy is hereby furnished.
TOTAL $3 3
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.) -
1 certify that in the performance of thg work for which this permit is issued,I shall not
employ any person.in any ma iter.so as to become subject to the Workers'Compensation
Laws of California 5
: wr t
Date � Owner
NOTICE TO APPLICANT: N, after'•'making this`'Certircate or Exemption you should become ZONE: BY:
subject 10 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 Cen n
Rear Setback from R p. Li
WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL,AND Side Street Setb Cen
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, Side Setback f m Prop�l Line
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ,
ATTORNEY'S FEES. - FINAL DATE SPECTER
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. Issued by: Date PerrS�
I agree to comply with all city and county ordinances and state laws relating to building• t5/A
construction, and hereby authorize representatives -of this city to -enter the above-. l7'n
mentioned property for inspection purposes. Validated by: V
Signature of applicant -Date-
Mailing.Addres
ateMailing.Address Validation:
City, State, Zip
r
CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBIN3j FEES
1ST FL. SO.FT.® $ UNITS
2ND FL. SO.FT.@ YARD SPKLR SYSTEM
FOR. SO.FT.® MOBILEHOME SVC. BAR SINK
GAR. SO.FT.® POWER OUTLET ROOF DRAINS
DRAINAGE PIPING
CAR P. SO.FT.
WALL SO.FT.® DRINKING FOUNTAIN.
SO.FT.® URINAL
ESTIMATED CONSTRUCTION VALUATION $ WATER PIPING
NOTE:Not to be used as property tax valuation FLOOR DRAIN
MECHANICAL FEES WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH)
APPLIANCE DRYER 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
SO.FT.GAR®3/ac HOUSE SEWER
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 ROCK STORAGE
FOUND.REINF. GAS(ROUGH) METER LOOP HEATING(FINAL) OTHER APP./EOUIP.
REINF.STEEL GAS(FINAL) TEMP.POLE
GROUT WATER HEATER SERVICE FINAL INSP.
BOND BEAM WATER SYSTEM
GRADING
LUMBER GR. FINAL INSP. A// cu.yd.
FRAMING FINAL INSP. $ plus x$ =$
ROOFING REMARKS:
0SP
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
ot
SPARK ARRESTOR v
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL