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06607 (ELEC)T4ht " P.O. BOX 1504 No, 4660 Building 78-105 CALLE ESTADO Address 49-826 CUCHELLA DRIVE LA QUINTA, CALIFORNIA 92253_ Owner ftp AND yt�S RAT �eEN Mailing BUILDING: TYPE CONST. OCC. GRP. Address SA2".E A.P. Number City Zip Tel. LA QUMA 92253 Legal Description Contractor Project Description INS+ 200 AMP SERVICE TASCRET35 SERVICE ELECTRIC CORPORATION Address 75-090 JOHI DRM WEST, #14 City PALM DESERT Zip 9226() Te1.568 -4WOO State Lic. City & Classif. C 10 502256 Lic. # 1569. Sq. Ft. No. No. Dw. Arch., Engr., Size Stories Units Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Address Tel. 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 SIGNATUREY - s it ✓ DATE OWNER -BUILDER DECLARATION] Estimated Valuation I hereby affirm that I am exempt from the Contractor's License Law for the following _0I reason: (Sec. 7031.5,Bustness 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 AMOUNT requires the applicant for such permit to rile a signed statement that he is licensed pursuant to PERMIT 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 for the alleged exemption. Any violation of Section 7031.5 by 'any applicant for a permit Plan Chk. Dep. subjects the applicant to a civil penalty of not more than five hundred dollars ($500). Plan Chk. Bal. ❑ 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 Const. Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon and who does such work himself or through his own employees, Mech. provided that such improvements are not Intended or offered for sale. If, however, the building orimprovement is sold within one year of completion, the owner -builder will have the burden Electrical • of proving that he did not build or improve for the purpose of sale.) ❑ 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 owner of property who builds or improves thereon, and who contracts for S.M.I. such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) Grading ❑ I am exempt under Sec. B. & P.C. for this reason Driveway Enc. Date Owner Infrastructure 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 ❑ Copy is filed with the city. ❑ Certified copy is hereby furnished. TOTAL -- - ✓ a CERTIFICATE OF EXEMPTION FROM REMARKS WORKERS' COMPENSATION INSURANCE rr (This section need not be completed if the permit is for one hundred dollars ($100) valuation or less.) 1 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 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 comply with such provisions or this permit shall be deemed revoked. Minimum Setback Distances: Front Setback from Center Line Rear Setback from Rear Prop. Line CONSTRUCTION LENDING AGENCY Side Street Setback from Center Line I 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.) Side Setback from Property Line Lender's Name Lenders Address INSPECTOR This is a building permit when properly filled out, signed and validated, and is subject to FINAL DATE 10jsOjOR expiration it work thereunder is suspended for 180 days. 1 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 -of this city to enter the above. mentioned property for inspection purposes. Validated by: Signature of applicant Date Mailing Address Validation: City, State, Zip CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL SO. FT. ® $ UNITS COLL. AREA SLAB GRADE ROUGH PLUMB. YARD SPKLR SYSTEM 2ND FL SO. FT. HEATING (ROUGH) STORAGE TANK FORMS MOBILEHOME SVC. BAR SINK POR. SQ. Fr. DUCT WORK ROCK STORAGE GAR. SQ, FT. ® POWER OUTLET ROOF DRAINS HEATING (FINAL) DRAINAGE PIPING - CAR P. SO. FT. ® GAS (FINAL) TEMP. POLE WALL SO. FT. DRINKING FOUNTAIN. GROUT WATER HEATER URINAL SO FT ® FINAL INSP. ESTIMATED CONSTRUCTION VALUATION $ WATER SYSTEM WATER PIPING NOTE: Not to be used as property tax valuation GRADING cu. yd. plus x$ FLOOR DRAIN MECHANICAL FEES WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER / /I/�� ,1� GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED LAUNDRYTRAY AIR HANDLING UNIT CFM VENTILATION 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 GAR. FIREWALL SQ. FT. ® c WATER HEATER MAX HEATER OUTPUT, B.T.U. SQ. FT. RESID ® 1% c SEWAGE DISPOSAL SO.FT.GAR ® 3/ac HOUSE SEWER 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 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 / /I/�� ,1� 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 t(/'`�jp \I j ��/,j( CITY OF LA QU I NTA /'�Y fel (�L!l.l (�Cf2 �/�i 1 n ractor Address, (�� r �'�(�'• +> I KS M U S S E IV Job Address Vef A) 6 CC -h(_ -NEL Ll L c_�r� _0 This form shall be posted on the job with the Building Inspection Card at all times in a conspicuous place. It is the responsibility of the General Contractor or the Owner/Builder to monitor the sub -contractors that are on this list are the same persons performing the work. Any changes of this list must be approved by the City of La Quinta Department of Building and Safety prior to work being performed by a changed sub -contractor. Failure to comply will result in a stoppage of work and/or the voidance of building permit. TRADE SUB -CONTRACTOR NAME CONTRACTOR'S LICENSE NO. WORKMAN COMP. NO. ON FILE CITY BUSINESS LICENSE NO. GRADE/ EXCAVATE t i PIPELINES I CEMENT/ FOUNDATIONS UJ KEuk CEMENT/WALKS & DRIVES ` - ASPHALT FRAMING STRUCTURAL 1 �• S 1 r fZ L_-_ MASONRY PLUMBING LEAF LATHING Doo- ' 3[,c, / Pi , li,. C) DRYWALL 5c) o/� � 6 3 -SWA3 19'4