14888 (ELEC)Building
Address
Owner
P.O. BOX 1504 No. 14888
78-495 CALLE TAMPICO
78-002 Coachella tar. LA QUINTA, CALIFORNIA 92253
Colony Cablevision
Mailing ]BUILDING: TYPE CONST. OCC. GRP.
Address Box 368
City '.n Zip
Palm Aeasr'-, Cif 92261
i Contractor
i Cochran Co==nicati6ns
36634 Cathedral Canyon
346'131.2
CityCa'�h>~t3xsl ^., CA 922e1328�-6778
i State Lic. City
Lic. #
& Classif. C7 478543 865
i
I Arch., Engr.,-
Designer
Address Tel.
' City (Zip (State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
000) of Division 3 of the Buslnes6 and Professions Code, and my Iicens Is in full force and
ffect.
' .,C'+•°� /`rte
I y SIGNATURE DATE
i OWNER -BUILDER DECLARATION
I
I hereby affirm that I am exempt from the Contractor's License Law, for the following
reason: (Sec. 7031.5,Business and Professions Code:. Any city, or county which requires a
permit to construct, atter, 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 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
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 of 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 or completion, the owner -builder will have the burden
of proving that he did not build or improve for the purpose of 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 COpCnsation insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Pol Icy,�N0- Company
Ef'Copy is filed with the city, ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed it 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 any manner so as to become subject to the Workers' Compensation
Laws of California.
Date Owner
NOTICE TO APPLICANT, lf,' 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.
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND
SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE
HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION,
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND
ATTORNEY'S FEES.
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.
Icertify 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
ateMailing Address
City, State, Zip
A.P. Number
Legal Description
Project Description 108 amp meter pedestal
Sq. Ft. No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑- Repair ❑ Demolition ❑
Estimated Valuation $700.00
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
33.50
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
33.50
REMARKS
ZONE: BY:
Minimum Setback Distances:
Front —Setback from Ce ine
Rear Setback from ro Line
Side Street Setb m Cente ine
Side Setback Property '
FINAL DATE INSPEY�R
Issued by: y Date -C?ermit
Validated by:
{.
Validation:
1
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. ® $
UNITS
SLAB GRADE
2ND FL. SO. FT. p
BONDING %jS�
YARD SPKLR SYSTEM
STORAGE TANK
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
DUCT WORK
ROCK STORAGE
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
HEATING (FINAL)
OTHER APPJEQUIP.
DRAINAGE PIPING
CAR P. I SO. FT. ®
TEMP. POLE
WALL SO. FT.
GROUT
DRINKING FOUNTAIN.
SO. FT. ®
FINAL INSP.
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER SYSTEM
WATER PIPING
NOTE: Not to be used as property tax valuation
,
_$
FLOOR DRAIN
MECHANICAL FEES
i
FINAL INSP. ) 4,s
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
I
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
GAR. FIREWALL
SO. FT. @ c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID @ 1 % c
SEWAGE DISPOSAL
SO.FT.GAR @ 3/ac
HOUSE SEWER
INSULATION/SOUND
GAS PIPING
PERMIT FEE
FINISH GRADING
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 %jS�
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.
i
FINAL INSP. ) 4,s
FRAMING
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL S
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL