06121 (ELEC)- No:
P.O. BOX 1504
Building",'. � ,, � Ss� i ern i $ S 78-105 CALLE ESTADO
Address » LA QUINTA, CALIFORNIA 92253 • ,
Owner
` Mailing
' BUILDING: TYPE•CONST. -0CC: GRP: +�
Address 42--500 Cook St . , Suite 200 -PGA Vast
A.P. Number
City, ' Zip Tel.
' Desert, 9..22601. �5 8=2828 Legal Description
Contractor -. P T@ ra power
, Project Description �' P
National, re s.88td ... ,
-Address
'• City Zip Tel.: ,
State Lic: City
& Classif. ' .2881130 ' Lic. # , 328
_ , .. .M„ ,..� Sq. Ft. No., . No. Dwr
Arch., Engr.; Size Stories Units'
` 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 ofrthe Business arid;Professions Code, and my license is in full force°anCi f� 4
effect. > �. -771
SIGNATURE 1 A...+io` Y. -. .•l.+' '*a••t..f"" A'— 41 (DATE
• OWNER -BUILDER DECLARATION Estimated Valuation y r
I hereby affirm that 1 am exempt from the Contractors License Law for the following.
reason: (Sec. .703 1.5, 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 PERMIT AMOUNT + K
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 lhe'applicant to a civil penalty of not more than five hundred dollars.($500). I,
❑.l, as owner of the property, or my employees with wages as their sole compensation, will Plan Chk. Bal.
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and iiOrlSt.
Professions Code: The Contractor's License Law does not apply to an owner of property who' - '
builds or improves' thereon and who does such work himself or through his•own employees,. Mech. • '
provided -that such improvements are not intended or offered for.sale. If, however,- the building -
or improvement is sold within one year of completion, the owner -builder will have the burden Electrical ]LJ all)
S ,-
of proving that he did not build or improve for the purpose of sale.) -
❑ 1, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing
` •-struct-the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law f
does not apply to an owner of property who builds or improves thereon, and who contracts for S.M.I.
such projects with, a contractor(s) licensed pursuant to the Contractor's License Law.)
Grading
❑ 1 am exempt under Sec. B. & P.C: for this reason - -
Driveway Enc. ,
a
Date owner Infrastructure '
WORKERS' COMPENSATION DECLARATION
r - Ihereby affirm that Ihave a certificate„of consent to self -insure, or a certificate of
Workers Compensation Insurance, or a certified.copy;thereof. (Sec. 3800, Labor Code.) ri -
Policy No. Aompy . ",,ani
�. •'�, . r . .
❑ Copy is filed with the city. • ❑ Certmed'copy is hereby furnished.
TOTAL
CERTIFICATE OF EXEMPTION FROM REMARKS' r$�1as'':i�f;ta'��i�1�';�•X+
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100) valuation
or less.)-
• 'I certify tliat in the performance of the work for which this permit is issued; I shall not f'
employ any person in any manner so as'to become subject to the Workers' Compensation
Laws of California. „
Date Owner it
NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become ZONE: - BY: - -
subject to the Workers' Compensation' provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked. _ Minimufrt Setback Distances: _
c Front Setback from Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY •: - Side Street Setback from Centel Llne
I 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 '
Lenders Name -
Lenders Address ” FINAL DATE INSPECTOR
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.7�26/89 It
I.cerlity 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 I
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. Fr. ® $
UNITS
SLAB GRADE
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL SO. FT.
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
POWER OUTLET
ROOF DRAINS
GAR. SO. FT. ®
TEMP. POLE
GROUT
DRAINAGE PIPING
CAR P. Sp. FT. ®
I
BOND BEAM
WATER SYSTEM
DRINKING FOUNTAIN.
WALL SQ. FT.
=$
LUMBER GR.
FINAL INSP.
URINAL
SQ. FT.
ROOFING
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(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 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.
SQ. FT. RESID ® 1Vi c
SEWAGE DISPOSAL
FINAL INSPECTION
SO.FT.GAR ® 3Yac
HOUSE SEWER
CERT. OCC.
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. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
/I
�G
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITtALS
GARDEN WALL FINAL
)