003479 (ELEC)1 Y . U. o.
P.O. BOX 1504 NO.�
Building 78-105 CALLE ESTADO
' Address 78-120 San Timeteo LA QUINTA, CALIFORNIA 92253 -
Owner ;
,.. ?fix'_ �» t•�1rxt_ ��v.�arr�1 1
Mailing
BUILDING: TYPE CONST. OCC: GRP.- -
� -
Address �-�-r� �, •.�..x :. A.P. Number La t^'s�1 nta Golf Pa erten
....City �...., __ Zip` .' Tel.
-baa - Qwii1s`8 �2 �a " Legal, Description
Contractore
_. Project Description s � [` r i3 t Xa fnlr
er / zed. ui ldf. r
Address .:. .-relf•lection 000l . .._ ..
City.. ..... .. .... ... -Zip._
Tel_ ...
State Lic.
City
& Classif..
Lic. #
Sq. Ft.,
No. No. Dw.
Size :--
Stories - Units -
•
Arch., Engr., _. ... ,
: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
effect.. -
_-
_
SIGNATURE DATE
OWNER -BUILDER DECLARATION
. I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Bus1ness 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 file 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): .' •'
❑ 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
- Professions Code: The Contractor's License Law does•not apply to an owner of property, who
"who
Estimated. Valuation
.. '. -• • • -
,: PERMIT
*'
-- AMOUNT
-
Plan- Chk..Dep. .
- - -
.
- Plan Chk. Bal.. .
_ ..
Const.,
Mech.`
builds. or improves thereon and 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. •'
of proving that he did not build or improve for the purpose of sale.) ,
Electrical
Plumbing
O I, as owner of the property, am exclusively contracting with licensed contractors to con..-.
• slruct :•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.) -
.p Lam.exempt under Sec. » i• B: & P.C. -for t�his,reason
S'. M. 1. ' • '-
,
-
Grading
Driveway Enc.
Date �•r�/ff 7Owner b AtA.r fi". €Lt:/• JI
Infrastructure
f
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.+3600, Labor Code.)
Policy No. - Company
.0 Copy is filed with the city., O Certified copy is hereby. furnished.,
TOTAL
CERTIFICATE OF EXEMPTION FROM
WORKERS'. COMPENSATION INSURANCE
REMARKS
(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 any person in any man0er so as to become subject to the Workers' Compensation
Laws of Califorania. aY,� tn7 ct
Date t s'r':rOwner `:,erk6 0,t"f 1.E. r°1
y J«CJ '� ii.1S 1'.. "f iiF i�l
ti �=',gkf{ 9 !';;,}f 4� in
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. ''
ZONE:
- Minimum Setback
BY:', _
Distances: -
Front Setback.from Center.Line
,
_
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of the
work for which this permit.is issued. (Sec. 3097; CivilCode.).
Side Street Setback from Center Line '
Side Setback from Property Line
Lender's Name
FINAL DATE'
'ISSUed by:
--
Validated by:
- _ INSPECTOR
Datell/C/87 Prmit
•- �• -
Lender's Address
• - 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:
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 �of,-this cityto enter the above-:
mentioned property for inspection purposes.
Signature of applicant Date
'Mailing Address
Validation:
City, State, Zip
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBINre FEES
1ST FL. SO. FT. ® $
2ND FL. SO. FT. ®
POR. 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
v
je0NDING — Y cG
'ROUGH
FLOOR DRAIN
MECHANICAL FEES
FORMS
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APPJEOUIP.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
TEMP. POLE
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
FINAL INSP.
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ac
HOUSE SEWER
VENTILATION
GAS PIPING
PERMIT FEE
FIRE ZONE ROOFING
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.
v
je0NDING — Y cG
'ROUGH
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
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
4
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL