003013 (ELEC) - IIlIIIIIIITIIIVIIIIIII 26 �.
IE
P.O. BOX 1504 No. 003013
Building. 78-105 CALLE ESTADO
Address 80-202 Avenue 58 LA QUINTA,CALIFORNIA 92253
Owner
Mailing
TIM, 1went BUILDING: TYPE CONST. OCC:-GRP.
Address '
A.P. Number
City ZipTel.
La E)uinta 32253 . Legal Description
Contractor Project Description Tp'11mRr3ra V nnWAr ncw*tt*
eavanauczh Ei tric _
Address
83-1213 HWY i33
City - Zip Tel." `
1?1+i�4 9220Y ?47-3606
State Lic. C;qo City
&Classif.. 1"1Lic.# 32 ' Sq. Ft. No. No. Dw.
� $"�% Size Stories. Units
Arch.;Engr., - -• - -
Designer New ❑ Add ❑ Alter ❑ Repair❑ Demolition ❑
Address Tel.
City Zip State
Lic.#-
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section xr
f 7000)Of Division 3 of then;Business and Professions Code,and my license is in full force and
.�effect. — ,:R-7
SIGNATURE DATE
OWNER-BUILDER DECLARATION Estimated Valuation
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 '
peimit 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 PERMIT AMOUNT
the provisions or 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 violation or Section 7031.5 by'any applicant for a.permit Plan Chk. Dep.
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 Plan Chk. Bal.
do the•work,and the structure is not intended or offered for sale.(Sec. 7044,Buisness and COr1St. � •
Professions Code: The Contractor's License Law does not apply to-an owner of property who
UU
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 buildng
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 apply to an owner of property who builds or improves thereon, and who contracts for S.M.I. • •50
such projects with a contractors)licensed pursuant to the Contractor's License Law.)
Grading
❑1 am exempt under Sec. B,&P.C.for this reason
Driveway Enc.
Dale 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 --1,fir r'f " ;-rl ti+ 4,7:r•/r/rr.•
❑Copy is filed.with the city. ❑Certified copy'is hereby furnished.. i!
:74;1Y,,'-S7 TOTAL $20.50
CERTIFICATE OF EXEMPTION FROM REMARKS
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.
Ddte 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.- Minimum Setback Distances:
comply with such provisions or this permit shall be deemed revoked.
Front Setback from Center Line
Rear Setback from Rear Prop. Line
coNsrRucrloN LENDING AGENCY Side Street Setback from Center Line'
hereby affirm that there is a construction lending'agency for the performance of.he
work for which this permit is issued.(Sec.3097,Civil Code.) - Side Setback from Property Line
Lender's Name
Lenders 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.
I certify that I have read this application and state that the above information is correct. Issued by: Date Permit
1 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. - Validated by:
Signature of applicant Dale
Mailing Address Validation:
City, State, Zip
B7621 3 30 205b U
HARD COPY
CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES
IST FL. SO.FT.p $ UNITS
2ND FL. SO.FT.
YARD SPKLR SYSTEM
POR. SO.FT.® MOBILEHOME SVC. BAR SINK
GAR. SO.FT.® POWER OUTLET ROOF DRAINS
CAR P. SO.FT.
DRAINAGE PIPING
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 LAUNDRYTRAY
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. 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.FEECONST.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.IEOUIP.
REINF.STEEL GAS(FINAL) TEMP.POLE
GROUT WATER HEATER SERVICE FINAL INSP.
BOND BEAM WATER SYSTEM
GRADING
LUMBER GR. FINAL INSP.
cu.yd.
FRAMING FINAL INSP. $ plus x$ _$
ROOFING REMARKS:
VENTILATION .
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL