001741 (ELEC)P.O. BOX 1504 No.. 001741
Building -n-M mue Temte 78-105 CALLE ESTADO
Address LA QUINTA, CALIFORNIA 92253
. Owner _ . .. .. - .. .. .. ....._ ...
E.Le. yeaq= omlsstmlct�
BUILDING: TYPE CONST: OCC..GRP.,
Mailing
Address P.O. !z 27 A.P. Number
City Zip Tel.
Contractor
f
Address- . ,.,. ..
a
"City
0
-92M2 714-684_5360 Legal Description
Project Descriptiotn. , CCiVl.. -V0+ 16
State Lic. City
& Class.if.Lic. # Sq. Ft.' No. No. Dw.
CA ��
Arch., Engr:, Size- • Stories Units
. ... '
Designer ��qq ��.yyp�+� New 0 Add ❑ Alter ❑ Repair ❑ Demolition'❑
Address Tel.
619-3"-2651
City Zip State
.-.. ��. Lic. #
LICENSED CONTRACTOR'S DECLARATION
hereby affirm that I amt licensed under. provisions of Chapter 9 (commencing with Section ' f
7000) of Division 3 o the Business and Professioiis'Code, and my.license.isin full force and -
effect . I
nd-effect.I . i`r/ .. .. .,.v` " / � . � . .
SIGNATURE tr.-' l" 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 county, which requires a
'
.or.
-,permit to construct,'alter, improve, demolish, or repair any structure, prior to its issuance also
,
rr• -
requires the applicant for such permihlo file a signed statement that he is licensed. pursuant to
PERMIT
- •• ' AMOUNT --�
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
'
Division -3 'of the Business and Professf6ns Code, or -that. he is exempt therefrom, and the basis
for the Any Section- 7031.5 by 'any for
Plan ChK.. Dep.
alleged. exemption. violation of applicant a' permit
subjects'the applicant to a civil penalty of not more than five. hundred dollars ($500): - : •' ' ".-
Plan Chk. Bal.
-
-
❑ I, 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
COgSt.
w
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,
MBCK.
- -
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.) . •- -
-O 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' -• .
M. 1. -
- •- -
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
-
Grading
❑ 1 a exempt.under Sec. B. &•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
..
O Copy is filed with the,city. , ❑ Certified copy is hereby furnished.
TOTAL
20,00
CERTIFICATE OF EXEMPTION FROM -
REMARKS
WORKERS' COM PENSATION.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 the 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
ZONE:
BY:
' subject' to the "Workeis' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
.Minimum Setback Distarices:' -
Front Setback from Center -Line
Rear Setback from Rear'Prop. Line
CONSTRUCTION LENDING AGENCY.-
Side Street Setback from Center Line
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
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. -
I certify that I have this ' '.
Permit
read application and state that the above information is correct.
' I'agree to
Issued by.
Dater&'Tom•
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. f
Validated by:
Signature of applicant
• Mailing Address ; f / + - f J -
Validation:
_
City, State, Zip
A 2 8 0 1
10 7 20.00 CK
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
2ND FL. SQ. FT.
POR. SQ. FT. ®
GAR. SO, FT, ®
CAR P. SQ. FT.
WALL SQ. 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.
LAUNDRYTRAY
AIR HANDLING UNIT CFM
TEMP. POLE % G;
88
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.
SQ. FT. ® c
BATH TUB
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID.® 11/a c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ac
HOUSE SEWER
REMARKS:
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.]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. POLE % G;
88
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ -Plus-X$-=$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
' / ^
7
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 SIGNATURES/INITIALS,
GARDEN WALL FINAL