15640 (ELEC)414
P.O. BOX 1504
Building 51-870 Ave. Rubio LA pUINTA, CALIFORNIA 92253
Address
Owner Earl Dixon
No. x.5540
Mailing
BUILDING: TYPE CONST. OCC: GRP.
Address aI$2Yle
A.P. Number
City
Zip
Quinta., CA 92253:
Contractor.
Bl&ir • Hlectric Co. Inc.
Address
.85-100 Ave., 44
CI'a io, Cts Zip 92203
State Lic:
& Classif, . C;-10. 397593
Tel. ,
Legal Description
Project Description "16—place 200 amp maim p6nel
Tel
City
Lic. # 1197 Sq. Ft. N_ No. Dw.
Arch.; Engr:,
Size
Stories Units l
Designer
New ❑ Add ❑
"r,Alter ❑ Repair ❑ Demolition ❑
Address
Tel.
_
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
—BY: -.-
Minimum Setback Distances:
CityZip
State
Rear Setback from Rear Prop: ine. '
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND
�..
Side Street Setback fr� Ce"(iter Lin .
L'ic. #
($100,000), ADDITION .
Side Setback from PI� erty Liner , 1�
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND .
ATTORNEY'S FEES.
LICENSED CONTRACTOR'S DECLARATION
FINAL DATE
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
1000) of Division 3 of thee Businesss,and Professions Code, and my license is in full force and-
This is a buildin g permit when property filled out, sighed and validated, and is subject'to
expiration it work the• •
reunder is suspended for 180 days.
✓ w / ,�
- •� ,l /v/
I certify that I have read this application and state that the above. information is correct. -
Issued by:
a$IGNATURE ,..r.+a' _.•--,.._.......,,,M,.r- ,,.. -. DATE
I agree to comply with all city and county ordinances and state laws relating; to building
construction, and hereby authorize representatives this
.;
OWNER -BUILDER DECLARATION
I hereby that 1 from the Contractor's License Law for following
Estimated ValuationC
ea
$850.00
affirm am exempt the
reason: (Sec. 7031.5,Business and. Professions .Code: Any city or county which requires a
Signature of applicant Dale
permit to 'construct, atter, Improve, demolish, or repair any structure, prior to its issuance also
Mailing Address
- -,
' requires the applicant for such permit to file a signed statement that he is licensed pursuant to
PERMIT
i
- AMOUNT
the provisions of 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 -
the alleged exemption. Any violation Section. 7031.5 by any for
Plan Chk. Dep.
.for of applicant a permit
subjects the applicant to a civil penalty of not more than rive hundred dollars (8500).
-
Plan Chk. Bal.
,
-
❑ 1, 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, Buisness and
COrISt
Professions Code: The Contractor's License Law does not apply to an owner of property who
.
X
builds or improves thereon and who does such work himself or through his own employees,MBCh
'
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 '
r 33
_ of proving that he did not build or onprove for the purpose of sale.)
•
O 1, 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 ownet,•ofproperty, who builds or Improves thereon, and who contracts for
S.M.I.
such projects with a contraotor(s) (fcensed pursuant to the Contractor's, License Law.) • -
Grading
❑ I am exempt under Sec. B. 8 P.C. for this reason
,
Driveway Enc.
Date Owner
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 - Cpmpany
,b�py is filed with the city. ❑ Certified copy is hereby furnished..
CERTIFICATE OF EXEMPTION FROM '
WORKERS' COMPENSATION INSURANCE'
(This section need'not be,completed N the permit is for one hundred dollars (8100) valuation
or less I '
Infrastructure
TOTAL 33.50
REMARKS
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
Date Ownera
NOTICE TO APPLICANT: N, after making this Certificate of Exemption you should become
. ZONE: -
_
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
—BY: -.-
Minimum Setback Distances:
Front Setback from Center Line-
Rear Setback from Rear Prop: ine. '
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND
Side Street Setback fr� Ce"(iter Lin .
SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE
HUNDRED THOUSAND DOLLARS IN TO THE COST OF COMPENSATION,
($100,000), ADDITION .
Side Setback from PI� erty Liner , 1�
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND .
ATTORNEY'S FEES.
) I
FINAL DATE
"" INSPECTOR,
This is a buildin g permit when property filled out, sighed and validated, and is subject'to
expiration it work the• •
reunder is suspended for 180 days.
✓ w / ,�
- •� ,l /v/
I certify that I have read this application and state that the above. information is correct. -
Issued by:
"Date Permit
I agree to comply with all city and county ordinances and state laws relating; to building
construction, and hereby authorize representatives this
` 1.
-of city .to enter the. above-.
mentioned property for inspection purposes.
Validated by:
1
Signature of applicant Dale
Mailing Address
Validation:
-City, State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBIWU FEED
1ST FL. SO. FT. ® $
UNITS
SLAB GRADE
2ND FL. SO. FT.
BONDING
YARD SPKLR SYSTEM
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SO. FT.
GAS (ROUGH)
DRAINAGE PIPING
WALL SO. FT.
OTHER APPJEOUIP.
DRINKING FOUNTAIN
SO. FT. ®
TEMP. POLE
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GROUT
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SYSTEM
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
FINAL INSP.
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
.
I IKITCHEN 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 ® 11A c
SEWAGE DISPOSAL
GAR. FIREWALL
SO.FT.GAR ® 3/ac
HOUSE SEWER
LATHING
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 APPJEOUIP.
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 f 41
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL 71