ELEC (003030)56501 Madison St
003030
Building ' 78.105 CALLE ESTADO
AddressZSW LA QUINTA, CALIFORNIA 92253
Owner.... _ . .• ,. .... ... ... ... ., ., .. ,...
• ` T > . _ "" BUILDING: TYPE CONST. OCC: GRP:`
Mailing
Address '
A.P. Number
-City Zip Tel,
Legal, Description
- ...
CAProject
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I.
Address.. _.. ,.. .
City _ . Zip . _ .. Tel...
92201 619"-34i 3600.
State Llc. City M
& Classif. C--10.. 286936. Lic. # 32.. `Sq: Ft, .. No.. No. Dw.
"
Size • Stories Units
Arch.; Engr:
Designer New :.: Add -0 Alter q. '-Repair ❑ -Demolition 0 -
Address Tel.
City Zlp State
Lic.#...
LICENSED CONTRACTOR'S DECLARATION'
I hereby affirm that I am licensed under provisions o} Chapter 9 (commencing with Section - + '•
7000) of Division of he Business and Professions Code, and my license Is -in full force and
.effect..,
SIGNATl1RE
OWNER•BUILDER DECLARATION :' }
I hereby affirm that I am exempt from the"bontractor's License Law for the following Estimated .Valuation
reason:_ (Sec. 703%5dBuslness end Professions Cogs: 'Any city or, county .which requires -a
permit to construct, eller;.fniprove,"demolish, or repslr•any structure,' prior to Its Issuance also :•
requlres.the applicant for' such.permlt to file a signed statement that he Is licensed pursuant to PERMIT• AMOUNT
the. provisions of the Contractor's License Lew, Chapter 8 (commencing with Section 7000) of
Division 3 o the Business and Professions Code, or ,that, he 7s; exempt therefrom,. and the basis
'
for.. the aPlan
lleged exemption. Any' violation• of Section 7031.5..by "any. applicant for a permit :.Chk .Dep.
subjects the applicant to's civil penalty of not more then 'five hundred dollars ($800).
❑ 1 as owner of the property, or, my employees with wages as-thelr sole compensation, will x Plan. Chk.. Bal.
do {he work,'and the structure Is not intended or -offered for sale. (Sec. 7044, Sulsness and Const.
Professions Code: The Contractor's License .Low does not apply to en owner of property who
builds or Improves thereon end who does such work himself, or •through - his own employees, Mech.
provided that: such_ Improvements ere, not Intended or offered for sale.. If;,however, the building.. -
or Improvement Is sold within one year of completion, the owner•builder..will have the burden . ' Electrical '
of proving,thaf he did not build or Improve for,the purpose of sale.) .
0. 1; as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing
• struct -the project. (Sec: 7044; Business and Professions Coder The Contractor's License Law
does not apply to an owner of property who builds or.lmproves thereon, and who contracts for S.M.I. = f$a
such projects with a contractor(s) licensed purauantdo the Contractor's License Lew.)
Grading f
❑ Lam exempt under Sec. B. & P.C.- for reason
r - ;
Driveway Enc.
Date • owner Infrastructure
w
" ORKER8'-COMPENSATION DECLARATION .
' ". ' I hereby affirm that I' have a'certificate of consent to-self-Insure,or a certificate of
Worker's Compensatlon.Insurance, or a certified copy thereof..(Sec: 3800; Labor Code.).
- ' PollcyNo.Company
❑ Copy Is flied with.the city... ❑.Certifled copy Is hereby furnished.
TOTAL 20.5E
CERTIFICATE OF'EXEMPTION FROM REMARKS'.
WORKERS' COMPENSATION INSURANCE e
(This section need not be completed 11 the permit Is for one hundred dollars ($100) valuation
I -certify that In the performance of th? work for which this mit Is lssued,.l shall not a.
employ any ppereon 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 of the Labor Code, you' must forthwith Minimum Setback Distancesi '
comply with such provisions or this permit shall be deemed revoked.
Front Setback from Center. Line
Rear Setback from . Rear, Prop..Llne
CONSTRUCTION LENDING AGENCY Side Street Setback -from Center Line
I hereby affirm that there is a constructlon lending agency for the performance of the - •
.•, work for whlch this permit Is_Issued. (Sec. 3087, Civil Code.) Side Setback from Property. Llne
Lender's Name
Lender's.. Address i
This Is a'buliding'permlt'when properly filled out,`slgned and validated; and is subject to FINAL.DATE ` INSPECTOR
expiration If work thereunder is suspended for 180 days. +, +
I.Certity'that l have -read -this application and state that the above Information Is correct. Issued by Date ' Permit
I agree'to'comply'with-all clty'•and'county ordinances and elate Tawe relating to building
construction; and hereby authorize representatives .sof this city- to enter the' above.. si
mant loned property for Inspection purposes. Validated. by:
Signature of applicant Date
Malling Addreas Validation:
City, Stale, Zlp,
- HARD COPY , . -
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
2ND FL. SO. FT. ®
POR. SQ. FT. ®
GAR. SQ. FT. ®
CAR P. S0. FT. ®
WALL SQ. FT. ®
$Q, 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.000L HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APP./EQUIP.
LAUNDRYTRAY
AIR HANDLING UNIT CFM
TEMP. POLE
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.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ac
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. 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./EQUIP.
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
11'IJr CIi vn A JW nM V nCJllnl INLJ,
GARDEN WALL FINAL