13421 (ELEC)4
uu�jtrc�
P.O. BOX 1504
Building 53-025 Ave. bio 78-105 CALLE ESTADO
Artrirpcc LA QUINTA, CALIFORNIA 92253
Owner Mrs. Bergman
Mailing Same
Address
City La Quintan
ZZII
kp 92253
Tel.
Cont=dley Electric Inc.
Addrp,11-741 Joni Drive
City
Palm Desert,
Zip
EA 9226Q
Tel.
341_9298
State Lic. C -l8 275466
& Classif.
City 2958
Lic. #
Arch., Engr.,
Designer
Address
Tel.
City ( Zip (State
t` >' Lic. #
LICENSED CONTRACTOR'S DECLARATION `,
I herebyy, affirm that Lam licensed under provisions"of Chapter 9 (commencing with S tion
300) of,Dfvision.3 of the Business and Professions Code, and'my'license is in full force and
nAT{
I hereby affirm that I am exempt from -the Contractor's License Law for the following
reason: (Sec. 7031.5,Susiness 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
requires the applicant for such permit to rile a signed statement that he is licensed pursuant to
the provisions o/ 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
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
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and
Professions Code: The Contractor's License Law does not apply to an owner o/ property who
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
or improvement is sold within one year of completion, the owner -builder will have the burden
o/ proving that he did not build or improve for the purpose or sale.)
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-
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
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
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. Company
opy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
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 anyperson 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
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY ,
1 hereby 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 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.
I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives sof this city to enter the above-
mentioned property for inspection purposes.
Signature of applicant Date
Mailing Address
City, State, Zip
No. 13421
BUILDING: TYPE CONST. OCC. GRP.
A.P. Number_
Legal Description
Project Description Electric Service Change to
125 AMP Service
Sq. Ft. No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation $1,100.00
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
15.00
Mech.
_
Electrical
18.50
Plumbing
S.M.I.
Grading
Daeermi
Driveway Enc.
Infrastructure
Validation:
TOTAL
3 3 • 5
REMARKS
ZONE:
BY:
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'
Issued by:
Daeermi
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
SLAB GRADE
' r
BONDING
YARD SPKLR SYSTEM
2ND FL. S0. FT. @
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING �/_ (�f
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
GAS (ROUGH)
METER LOOP
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
GAS (FINAL)
TEMP. POLE
DRAINAGE PIPING
CAR P. SQ. FT. ®
GROUT
WATER HEATER
WALL SO. FT.
FINAL INSP.
DRINKING FOUNTAIN.
BOND BEAM
WATER SYSTEM
URINAL
SQ. FT. ®
-$
LUMBER GR.
ESTIMATED CONSTRUCTION VALUATION $
FRAMING
WATER PIPING
NOTE: Not to be used as property tax valuation
-' "'
FLOOR DRAIN '
MECHANICAL FEES
REMARKS:
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.
SQ. FT. ® c
BATH TUB
MESH
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
FINISH GRADING
SQ.FT.GAR ® 3/ac
HOUSE SEWER
GAS PIPING
PERMIT FEE
MIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE EPL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
GARDEN WALL FINAL
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 �/_ (�f
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
FINAL INSP.
GRADING
cu. yd.
$ plus x$
-$
LUMBER GR.
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
LICENSED CONTRACTOR
NO. 275468
74.741 JONI DRIVE,
SUITE D-,,- PALM DESERT, CA 92260 •
(619) 346.9498 • FAX (619) 346.8789 -
- April`20 1994
Bergman
53-025=Avenida Rubio-
ubioLa
LaQuinta, California-
Electrical =Loads
Calculations
Load at 100%
_ Air Conditioning - _ _
- s
_-
3.30 KW.
.- 25% of -the largest load`.
.83 KW -
General Load- -
_ -
915. Square feet @ three watts: -
- 2.74 -KW =
' 1. - Stove oven combination, 220 volt
8.90 KW "
1-Dshwasher,120 volt.
1.20 KW -
1 Garbage disposal, 120 volt.
. _ --':70 KW
- 1 , Microwave, 120 volt. - : ' "
1.20 KW
v 1 Washer circuit, 120 volt. -
` -' 1.65 KW
"
' 1 .Refrigerators, 120.volt. .- - -
µ _ 1.08 KW
---------------
Total - - 1 " ..
1747'KW ;
First 10 KW @ 1000,46 r
10.00`KW
Remainder @ 40 % _ _; _
2.99 KW
Total _ -- `
- ; : ✓ - - . -
17.12 KW:
17.12 KW @ 220 VOLTS =,77.82 AMPS
-
-
-
- r Provide minimum service of 100 amps.
-
-
-
- ; �_