9637 (ELEC)4
P.O. BOX 1504 No. 9637
Building 78-105 CALLE ESTADO
Address 78005 Coronados Circle LA QUINTA, CALIF ORNIA 9225 3
Owner
Union Bank Trustee BUILDING: TYPE CONST.—OCC. GRP.�.__
Mailing
Address P. 0. Box 109 A.P. Number 617-360-002-3
c�'Yan Diego Zip 92112 ITel �
I
Contractor
Mapleleaf-Plumbing
Zip I Tel.:
State Lic. City
& Classif. 481393 Lic. # 171
Arch., Engr.,
Designer
Address Tel.
City lZip State
I Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7 00) of Division 3 of the Business and Professions Code, and my license is in full force and
ffect .
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,Business 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).
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
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 of completion, the owner -builder will have the burden
of proving that he did not build or improve for the purpose of sale.) . I .
a owner of the property, am exclusively contracting with licensed contractors to con-
sth,
stfuct e project. (Sec. 7044, Business and Professions Code: The Contractor's License Law
dies 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.)
0 1 am exempt under Sec.�B. & P.C. for this reason
Date Owner
4_J lov
WORKERS' COMPENSATION DECLA'0414 11��
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
Sb'?Copy is filed with the city. 0 Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS'COMPENSATION INSURANCE
(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 thp 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_Owne�
NOTICE TO APPLICANT It, 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.
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. 309 7, Civil Code.)
Lender's Nam
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 city to enter the above-.
mentioned property for inspection purposes.
Signature of applicaO -Date.
Maili ' ng Address
City, State, Zi
Legal Description
Project Description
Install gas meter
Sq. Ft. No. No. Dw.
Stories Units
New 0 Add 0 Alter El Repair El -Demolition 0
Estimated Valuation
PERMIT AMOUNT
Plan Chk.. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing JU. UU1
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS A AC2 4 A 0
ZONE: —BY:
Minimum Setback Distances:
Front Setback from Center Lin
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
—Side Setback from Property Line
FINAL DATE INSPECTOR
Issued by: � —Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. a $
UNITS
SLAB GRADE
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
I
2ND FL. SO. FT. @
FORMS
SEWER OR SEPTIC TANK
POR. SO. FT. 0 -
MOBILEHOME SVC.
BAR SINK
OAR. SO. FT. @
POWER OUTLET
ROOF DRAINS
CAR P. I SO. FT. (§)
OTHER APPJEQUIP.
DRAINAGE PIPING
WALL SO. FT. @
I
TEMP. POLE
DRINKING FOUNTAIN.
SO. FT. @
GROUT
URINAL
ESTIMATED CONSTRUCTION VALUATION $
FINAL INSP.
WATER PIPING
NOTE: Not.to be used as property tax valuation
WATER SYSTEM
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
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 SYST�M FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER. B.T.U.
SO. Fr. @ c
BATH TUB
SPARK ARRESTOR
SO. FT. @ c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U,
SQ. Fr. RESID @ 1% c
SEWAGE DISPOSAL
LATHING
SO.FT.GAR @ V4c
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERM EE
PERMIT FEE
DBL.
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEt
CONST. FEE ELECT.FEE
SMIFEE
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
ROCKSTORAGE
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
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION -
CERT. OCC.
FENCE FINAL
INSPECTOWS SIGNATURES11NITIALS
GARDEN WALL FINAL :d