06649 (ELEC)P.O. BOX 1504 No. 06649
Building ' 78-105 CALLE ESTADO
Address 53AQ0. Juarez LA QUINTA, CALIFORNIA 92253
Owner
i�stslav Co st > t >o
Mailing BUILDING: TYPE CONST. OCC: GRP.
-
Address
A.P. Number 174-151-00$
City Zip Tel.
Legal Description
Contractor Project Description Te�"y power for construction
Address SameTrailer `
City Zip Tela
State Lic. City
& Classif_ Lic_ # Sq. Ft. No. No. Dw.
Arch., Engr., Size Stories Units
Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition O
Address- Tet.
• s
CityZip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that l,arri"ficensed under provisions of Chapter 9 (commencing with Section
7e0) to. f Divisi'dn3of/ tfKe:B,u• sinessadProf5Sslans"Code;anA my liceneis,in full force and
O1 M/ 23
SIGNATURE .!�,f-�' DATE
r OWNER -BUILDER DECLARATION Estimated Valuation
I hereby affirm that I am exempt from the Contractor's License Law for the following �E3..
reason: (Sec. 7031.S,Business and Professions Code: Any city or county which requires a
permit to construct, after, Improve, demash, or repair any structure, prior to its issuance also
requires the,:appikant for such permit to toe 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 AMOUNT
Division 3 of the Business and Professions Code, or that -he is exempt therefrom, and the basis
for the�afleged exemption. Any violation of Section 7031.5 by -any applicant for a permit. Plan Chk. Dep.
subjects the applicant to a civi peraUy of not more than five hundred dollars (x500).
❑ I, as owner of the property, or my employees with wages as their sole compensation, will Plan Chk. Bal.
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and Const. $3Q�j
Professions Code: The Contractors License Law does not apply to an owner of property who
builds or improves thereon and who does such work hmnself or through his own employees, • Mech.
provided that such improvements are not untended 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 bald or improve for the purpose of sale.) Electrical
❑ 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 or property who bunds or improves thereon, and who contracts for S•M•l,
such projects with a contractor(s) Ammed pursuant to the Contractor's License Law.)
Grading
❑ 1 am exempt under Sec_ R- & 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, ora certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. Comfy
❑ Copy is filed with the city. ❑ Certified copy is hereby Iumished.
TOTAL (,i
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE REMARKS,7r. t r,•tr+ ,(ti . t�.�; - ; ,,.;
(This section need not be conpfeted ff the permit is for one hundred dollars ($100) valuation _ .:;Y'"SJ TI "r d t t k.,.. .i. ;A V : QV
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 manner so as to become subject to the Workers' Compensation
Laws of California
Date Owner
NOTICE TO APPLICANT: ff, after malfzwj this Certificate of Exemption you should become ZONE: BY:
subject to the Workers' Conpersatim provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shag 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
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.) Side Setback from Property Line
Lender's Name
Lenders 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.
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 '
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. S0. FT. ® $ "
UNITS
SLAB GRADE
(
BONDING
YARD SPKLR SYSTEM
2ND FL S0. FT.
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING.
MOBILEHOME SVC.
BAR SINK
POR. S0. FT. ®
GAS (ROUGH)
METER LOOP
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
GAS (FINAL)
TEMP. POLED �Q
DRAINAGE PIPING
CAR P. SO. FT. ®
GROUT
WATER HEATER
WALL S0. FT.
FINAL INSP.
DRINKING FOUNTAIN.
SO FT ®
WATER SYSTEM
URINAL
ESTIMATED CONSTRUCTION VALUATION $
=$
WATER PIPING
NOTE: Not to be used as property tax valuation
FRAMING
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTOXDISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
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.
SO. FT. ® c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
Sp. FT. RESID @ 1 Vi c
SEWAGE DISPOSAL
INSULATIONISOUND
SO.FT.GAR ® V4c
HOUSE SEWER
FINISH GRADING
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 APPJEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLED �Q
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
NSPECTION
FINAL INSPECTION-
CERT.
CERT. OCC.
FENCE FINAL -
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL