08184 (ELEC)Building
Address
Owner
. cerise art
Mailing ;
Address 8 �,
City '' Zip
ractor'•
City
State Lic.=r
& Class if.
e
Arch'-, Engr.,,
Designer.; . '
Address
(::eoolill 4-4
P.O. BOX 1504 NO. 08184•
78-105 CALLE ESTADO q
Irn Mals>, _ LA QUINTA, CALIFORNIA 92253'
t'tiicl' CBUILDING:. TYPE CONST OCC: GRP.
' ,fo A A.P. Number PGA West i�la
i Legal Description Tt? . _+ ase 1"
....
Project Description 100ai€t)i Tw Psi'
Land i
Tel
City
'Lic. # -
Tel. •
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City.`; , .:.:: ,•` Zip State .
Lic. #
LICENSED CONTRACTOR'S DECLARATION,
I he affirm that l,am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of the Busines's and Professions Code, and my license is in full force and
effect • fr A r N .. ``•3 /,..;,//
Sq. Ft. ' t No. No. Dw.
Size Stories Units.>
New ❑ Add ❑ r Alter ❑ Repair ❑ :,;�, :::Demolition
a" A' ❑
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SIGNATURE . -,�s 1f� l..,A.: L'r' •,�'V ' �' E� " / 1 / DATE
f OWNERBUILDER DECLARATION '
r`
I hereby affirm;that.I am exempt from the Contractor's License Law for the following
reason: (Sec:: 7031>S;Busiriess and Professions Code: Any city or county which requires a
permit to constiu-t; , alter,.. Improve, demolish, or repair any structure, prior to its issuance also
; requires Ihe,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. oh I e'IBusine§s 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
Estimated. Valuation
,..
i
c-
- PERMIT
•• -
AMOUNT -
Plan Chk. Dep.
.y ^
'• subjects the applicant too civil penalty of not more than five hundred dollars (S500).
0. I, as owner of.'the property, or my employees with wages as their sole compensation, will
PlanChk. Bal.
'
-
Const.
••` •'�-•• `
"do'the-work, and tfie•slructure is not intended or offered for sale. (Sec. 7044, Buisness and
ProfessionsCode., 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
Electrical
_
orimprovement 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.)
Plumbing
)
O 1, as owner of the property, am exclusively contracting . with licensed contractors to con-
' strucl the, project. ,(Sec. 7044, Business and Professions Code: The Contractor's License Law
•^*,: does, not apply to on 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.)
'
❑ 1 am exempl:under Sec. B. & P.C.,for this reason
Grading
Driveway Enc.
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•}��.
Date ' owner`o'�_ "•% �
Infrastructure
_
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WORKERS' COMPENSATION DECLARATION
I 'hereby affirm that 1 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
❑ Copy is filed with the city. 0 Certified copy is hereby furnished.
-
TOTAL
CERTIFICATE OF EXEMPTION FROM .
• - °' WORKERS' COMPENSATION INSURANCE - '
• (This section need .not be. completed if the permit is for one - hundred dollars (S 100) valuation
or less.):,a•
REMARKS
;
g;�; •4" 5.'� y4► .:T }i`� 7["' '�R y -<i 10, y;
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: If, after making this Certificate of, Exemption you should become
• subject 'to the Workers' the provisions 'of 'the , Labor ' Code, you must forthwith
comply withsuchprovisionsorthis permit shall be deemed revoked. •. - _
'Z ONE: - BY:
- --
•Minimum Setback Distances:;.
•
Front Setback from, Center. Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY
Side Street Setback from Center Line
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
Lender's Name
FINAL DATE
Issued by:'
Validated by:
INSPECTOR
Date 6 ��ermit' ••y
Lenders 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.'.
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 applicant. Date
Mailing Address
ValldatlOn:
City, State, Zip
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CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. ® $
UNITS
SLAB GRADE
2ND FL. SO. FT.
BONDING
YARD SPKLR SYSTEM
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO, FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SO. FT. ®
GAS (ROUGH)
DRAINAGE PIPING
WALL SO. FT.
OTHER APPJEOUIP.
DRINKING FOUNTAIN.
SO FT ®
TEMP. POLE
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GROUT
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SYSTEM
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FRAMING
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
REMARKS:
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
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1+/4 c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/4c
HOUSE SEWER
MESH
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
REMARKS:
VENTILATION
FIRE ZONE ROOFING '
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL