9659 (INST)P.O. BOX 1504 (� z.N o . 9659
Building 78-105 CALLE ESTADO
Address 78383 Highway 111 LA QUINTA. CALIFORNIA 92253
Owner \
Eisenhower Medical Center (I.C. Center)
Mailing BUILDING: TYPE CONST. OCC: GRP.-.
Address 78383 Highway 111
City Zip Tel.
La Quinta 92253
Contractor
Address
P. Number
Descripti
Description
install
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if One pend is for one hundred dollars (5100) 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 any manner so as to become subject to the Workers' Compensation
Laws of California
Date Owner
NOTICE TO APPLICANT: O, after making this CeroTicate of ExerrpOcn you - should become
subject to the Workers' Compensation provisions of One Labor Code, you must forthwith
comply with such provisions or this permit shaft be deemed revoked.
CONSTRUCTION LENDING AGENCY
Ihereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, Civil Code.)
Lender's Name
Lender's Address
This is a building permit when property 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
REMARKS
lU 4.;ASH I. IVIRL. I rV. t)t)
ZONE: BY: 1
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE INSPECTOR
Issued by: Date `Permit
Validated by:
Validation:
City -
Zip
Tel.:
State Lic.
& Classif.
City
Lic. #
Sq. Ft. No.
Size Stories
No. Dw.
Units
Arch., -Engr.,
Designer
New 0 Add O Alter 0
Repair 0 -Demolition 0
Address
Tel.
Any aues.tions call JC
at 773-1830
City
Zip
State
Lic- #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of the Business and Professions Code, and my license is in full force and
TWO' ,.
r"
SIGNATURE DATE
OWNER•BOILDER DECLARATION
I hereby affirm that I am exempt from the Contractors License law for the following -
reason: (Sec. 7031.5,Bustness and Professions Code:. Any oily or county which requires a
' permit to construct, atter, improve, demofsh, or repair any seuchoe, prior to its Issuance also
requires the applicant for such permit to Me a signed statement that hes Licensed pursuant to
the provisions of the Contractor's License Law, Cuter 9 (cermnencing wiOr Section 7000) of
Division 3 of the Business and Professions Code, or that. he is exemnpf therehom, and the bass
for the alleged exemption. Any vitiation of Section 7031.5 by 'arca applicant fora perms •
subiects the applicant to a civil penalty of not more than rive hundred dollars (5500).
Odl�'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, Busness and "
• ;;Professions Code: The. Contractors License Law does not appy to an owner of property who
_ builds or improves thereon and,who• does such work hirseff of through. Eris own ertpbyees,
'. provided that such improvements are riot Intended or offered for sale. fl, however. Ore budding _
' or improvement is sold within one year of cmpetian. One owner-0nider wit .have the burden-
or proving that he did not build or improve for the pupose of safe.) _
• ❑ I, as owner of the property, am exclusively contracting with licensed contractors to tort
struct•lhe project. (Sec. 7044, Business and Professions Code. The Canbactols License Law
does not apply to an owner of property -who builds or irpnoves thereon, and. who contracts for
such projects with a contractors) fcensed pursuant to Me Contractors License Law.)
❑ 1 am exempt under Sec- R. & P.C. for this reason
s ,rf r
Estimated Valuation
PERMIT
•r. V 'AMOUNT
Plan Chk. Dep.
-
Plan Chk. Bal.
Const.
r ,r
Mech., ,
•- ..
Electrical- '
Plumbing
30.00
S.M.I.
Grading
Driveway Enc.
Date Ownef�yn ll�
Infrastructure
f/
WORKERS' COMPENSATION'DECLARATION
I hereby affirnt'that I have a certificate of consent to selRinsure, or a certificate of
Worker's Compensation Insurance, ora certified copy thereof- (Sec. 3800, Labor Code.)
Policy No. Company
0 Copy is filed with the city. O Certified copy is hereby furnished.
TOTAL 30.00
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if One pend is for one hundred dollars (5100) 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 any manner so as to become subject to the Workers' Compensation
Laws of California
Date Owner
NOTICE TO APPLICANT: O, after making this CeroTicate of ExerrpOcn you - should become
subject to the Workers' Compensation provisions of One Labor Code, you must forthwith
comply with such provisions or this permit shaft be deemed revoked.
CONSTRUCTION LENDING AGENCY
Ihereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, Civil Code.)
Lender's Name
Lender's Address
This is a building permit when property 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
REMARKS
lU 4.;ASH I. IVIRL. I rV. t)t)
ZONE: BY: 1
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE INSPECTOR
Issued by: Date `Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SQ. FT. ® $
2ND FL. SQ. FT.
POR. SQ. FT. ®
GAR. SQ. FT. ®
CAR P. SQ. FT.
WALL SQ. FT. ®
SQ FT ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTEM
BAR SINK
I ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN.
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
HEATING (ROUGH)
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
DUCT WORK
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
HEATING (FINAL)
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.
SQ. FT. ® c
BATH TUB
BOND BEAM
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1% c
ISEWAGE DISPOSAL
LUMBER GR.
SQ.FT.GAR ® 31ic
HOUSE SEWER
FRAMING
FINAL INSP.
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) /y
_I
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
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
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION Uct t
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL