ELEC (08662)T-Atyl
.'`CII +' i <• . ,
P.O. BOX 1504 '�i.•i No.&'.
Building 7&105 CALLE ESTADO f '
Address 80
-183 HEYfdn LA QUINTA, CALIFORNIA 92253` .. i =;
Owner -
MIRISE
Mailing - + _ BUILDING TYPE CONST. +' OCC: GRP:
• Address 42-608 Cable Ss` e -t S% - Ate 208. A.P: Number .
City - Zip Tel. -
tais� f LIAR- _ Legal Description ' ion f� ,Ar1 O r I O? P,
Contractor
'uriu,caa: ..
SM
City .
State Lic,. -
& Classif. 2.881300 10
Arch., Engr., _ -
Designer
Address
Project Description an 1�-rp . T>+1�ng-.� 2��..�� 'Z5/c
Mn J- _= tam
Lic. # 328 LNew
Tel.
No.
- i
,,stories
Add ❑ Alter ❑ .
No. Dw.
,Units +"
Repair ❑ 'Demolition ❑
City •, r
Zip
State
'
Lic. #
"
LICENSED CONTRACTOR'S DECLARATION
4, y-
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 the Busi�ness P.iofessions
of and Code, a d my license is))i.n�€tfull force and
effect. r' _7
a:
T� -
- SIGNATURE f,I Ff 1 ,rtT'a 5.DANE
" .t ` 0WNEi(BU1LDERDECLARATION °
I hereby affirm that I am exempt from the Contractors License Law for -the following
season: '(Sec; 7031.5, Business and Professions Code: Any city or county which requires a �-
-. permit to: -construct, alter,`Improve, demolish, or repair any structure, prior to its issuance also
rewires the applicant for such permit to file a signed statement that he is licensed pursuant to
` 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
•:i /or the alleged exemption. Any violation of Section 7031.5 by'any applicant /or•a permit
Estimated Valuation -
-
PERMIT, AMOUNT
- _
Plan•Chk. Dep.` -
'
- subjects the applicant to a civil penalty of not more than five hundred dollars.($500). -
0-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, Bulsness and
{Professions Code: The Contractor's License Law does not apply to an owner of, property who
,.h 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
' 'is
•
Plan Chk. Bal..
Const. `•'_
_
Mech. - , 'y; C `>• '
•'`�:..
EI2CtfICal ^ • ..
or improvement sold within one year or completion, the owner -builder will have the burden
o/ proving that he. did not build or improve for the purpose o/ sale.)
Plumbing _
• ❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-.-
'
struct the project. (Sec. -7044, Business and Professions Coder The Contractor's 'LicenseLaw
: S. M.I.•
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.)
.❑ 1 am exempt under Sec. B. & P.C. for this reason
Grading r-
Driveway Enc. '
f
_
Date owner
Infrastructure 3
WORKERS' COMPENSATION DECLARATION
1.
I Rereby 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. ❑ Certified copy is hereby furnished.
3
TOTAL 3
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
REMARKS
- -
(This section need not be completed i/ the permit is for one hundred dollars ($100) valuation
or less.) ' ' - ' -•
I certify that in the performance of the work for which this permit is issued, I shall not
employ any person in'an'yjy manner so as to become subject to the Workers' Compensation
Laws of California.
ti
Date Own
�`{. Js
NOTICE TO'Al !CANT. If a.(ter making this.Certl/icate 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.. '
ZONE: -'-• BY: '
r - ,
Minimum Setback Distances: .. -
Front.Setback from Center, Line
-
Rear Setback from Rear Prop. Lirie' 'r
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending.agency for the performance of the
work fonw`ych this permit is issued. (Sec. ,3097, Civil code.) , ,
'Side Street Setback from Center Line
Side Setback" from Property Line
Lender's Name
Lender's Address
This is `a btrilding permit when properly filled out, signed and validated; and is subject to
expiration it work thereunder is suspended for 180 days.
FINAL'DATE' INSPECTOR
-
I certify that I have read this application and state that the above information is correct.
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.
Issued by: Date Permit
, ,
Validated by:
Signature of applicant -Date,-
ate'Mailing Address
Mailing
Valldatlon: -
City, State, Zip
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CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
2ND FL. SO. FT.
POR. SO. FT. ®
GAR. SO. FT. ®
CAR P. SO. 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
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APPJEOUIP.
LAUNDRY TRAY
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
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
REMARKS:
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.
&NAL 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 SIGNATURESIINITIALS
GARDEN WALL FINAL