001987 (ELEC)Building
Address
Owner
Mailing
Address
City
..
Contractor
Address .
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Zip ITel.
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P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number 7%4-21.4-f. 22
Legal Description f�
Project Description
City Zip Tel."
TA Wrft 922532
State Lic. City
& Classif. Lic. # Sq. Ft. No. No. Dw.
Size- Stories Units
Arch., Engr:,
Designer New„❑ Add ❑ .
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..
Alter ❑. '.Repair ❑ Demolition ❑
►. awe
_
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
Estimated Valuation
•°'�°" -
-
-' PERMIT
- - -AMOUNT
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
Plan'Chk. Dep.
.. '
�•
' subjects the'applicant to a civil penally of not more than five hundred'dollars ($500).
I, as owner of the property, or my.employees with wages as their,sole compensation, will
"
Plan Chk. Bal.
Const.
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
Mech. "
.
-
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'Electrical
of proving that he did not build or improve for the purpose of sale.) - -"
Plumbing
❑ 1, 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
S•M.I.
_ -
such projects with a contractors) licensed pursuant to the Contractor's License Law.)
. O I am exempt under Sec.-. B. t P.C. for this reason
Grading
-
Driveway Enc.
Date owner
Infrastructure
WORKERS' COMPENSATION DECLARATION
' 'I herebyaffirmthat I have a certificate-of'consent to selPinsure, or a certificate of
• Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No: Company
❑ Copy is tiled with the. city. _ O Certified copy is hereby furnished.
TOTALG`
a•'�
CERTIFICATE OF EXEMPTION FROM
WORKERS'.COMPENSATION INSURANCE
REMARKS
(This section need not be completed if the permit is for one hundred dollars ($100) 'valuation
orless:) ._ .. .. _. ...
certify that in the performance of thg work for which this permit is issued, I shall not employ -any person in -any -manner so as to become subject'to the Workers' Compensation
Laws of California.
Date Owner '
NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become
` subject to the 'Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked. ' -
ZONE: —BY:•
Minimum Setback Distances: - - -
Front Setback from Center Line
Rear Setback from.Rear Prop. Line
CONSTRUCTION LENDING AGENCY
I hereby affirm that i iere is a construction lending agency for the performance•of the .. .
work for which this permit is issued..(Sec. 3097, Civil Code.)
Side Street Setback from Center Line
Side Setback from Property Line .
Lender's Name
FINAL DATE INSPECTOR
'Issued by: Date a6 Permit
Validated by:
- Validation:
A3749 _.1.....$_. 221'5C Ck.
Lender's Address
• 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.
I certify that I have read this application and state that the above information is correct:—
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 1t -^'�'^ "! $ •f Date
Mailing Address ��" '
_
City, State, Zip 7
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HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBINC-51EES
IST FL. SO. FT. ® $
2ND FL. SO. FT.
POR. SQ. FT. ®
GAR. SO. FT. ®
CARP. SQ. FT.
WALL SO. FT. ®
SQ 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.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
P. 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.
SQ. 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
IvECH.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
UGH PLUMB./ ,23
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTI
UGH WIRING/ O�
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
GAS (FINAL)
P. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ -Plus-X$-=$
LUMBER GR,
FINAL INSP.
�MING' a3 0 �'
FINAL INSP.
ROOFINGl/ /
5 1v
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