003503 (ELEC)4 44
t it 49114a
P.O. BOX 1504 No. 003503
Building 78-105 CALLE ESTADO
Address 56w120�1-7ebbl.e Beach LA QUINTA, CALIFORNIA 92253
Owner
tit?nrign i.'ETmcan
Mailing BUILDING: TYPE CONST. OCC: GRP.
Address 75-005 Country Cl1b Drive A.P. Number FG. Went 71,l.i.i cr• � t- 47
City Zip Tel. '
Palm . De$ex't.- 42260 .• -_564-6716_ Legal Description
Contractor Project Description 248 X
gational Land A Mo2°"tac't ae
Address
City Zip Tela "
State Lic. City
& Classif. 28SI30 Lic. # 328 _ � . Sq. Ft. No. No. Dw.
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 t+
7000) of Division 3 of the }Business and Professions Code, and my license is in full force and
SIGNATURE a �.`w,,_-.i DATE
OWNER•BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following Estimated Valuation
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a '
permit to construct, alter, improve, demolish, or repair any structure, priorto its issuance also
requires the applicant for such permit to lila a signed. statement that.he is licensed pursuant to PERMIT -. AMOUNT
r the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of r
" 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 live hundred dollars ($500). • Plan Chk. Bal
0, 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 Const.�
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, Mech.
provided that such. improvements, are not intended or offered for sale. 1l, however, the building, -
or Improvement .is sold within one year of completion, the -owner-builder will have the burden EIBCtrICdl a Q1!
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. 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 Sea $. 8 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
CERTIFICATE OF EXEMPTION FROM REMARKS -
WORKERS'COMPENSATIONINSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100)valuation
or less.)' -
certify that in the performance of thg work for which this permit is issued, I shall'not'
employ any per in any manner soasto become subject to the Workers' Compensation 5 7:.` t s t` _ - (� # (�
Laws of California.
Date Owner
NOTICE TO APPLICANT: If, after making this Certificate ofExemption"you should become ZONE: BY:
'subject to the 'Workers' Compensation provisions of the Labor Code, you must forthwith Minimum Setback Distances: '
comply with such provisions or this permit shall be deemed revoked.
Front Setback from Center. Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY Side Street Setback from Center Line '
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.) Side Setback from Property Llne
Lender's Name
Lender's Address FINAL DATE INSPECTOR
This is a building permit when properly filled out, signed and validated, and is subject to /
expiration it work thereunder is suspended for 180 days. it 25�i
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 -of this city to enter the above-.
mentioned property for inspection purposes. Validated by:
Signature of applicant Date
Mailing Address Validation:
City, State, Zip
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
2ND FL. SO. FT.
FOR. SO. FT. ®
GAR. SO. FT. @
CAR P. SO. FT.
WALL SO. FT. ®
SO. FT. ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
BONDING
FLOOR DRAIN
MECHANICAL FEES
FORMS
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APP.IEOUIP.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
TEMP. POLE
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
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/a c
SEWAGE DISPOSAL
SO.FT.GAR ® 34c
HOUSE SEWER
REMARKS:
VENTILATION
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 APP.IEOUIP.
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
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL