14830 (ELEC)r
44Q
P.O. BOX 1504 N o . 14830'...
Building78-495 CALLE TAMPICO
Address 55-485 i . SCuther- Hills LA OUINTA, CALIFORNIA 92253
OwnerZS1.
Mailing - BUILDING: TYPE CONST: OCC: GRP.
Address
A.P. Number
City Zip Tel.
Legal Description
Contractor - amp .pedestal for
ltdn �+ a t%ne2 Electric Project Description
Address Ledbetter golf tress for
3€3-471 Bei A..r
City Zip Tel::
cathedral Citi 92234 321-2036
State Lic. City
& Classif.. . CIO 510541 Lic. # Sq. Ft. No. No. Dw.
Arch., Engr., - Size • - Stories Units
`Designer" New.❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address Tel.
City " Zip State _.
Lic. #
o LICENSED COV-RACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter (commencing with Section .
7�ff ) of Division 3 of the Busland Professions. Code,and my license is in fulj.force and
JSI�LURE DATE
OWNER-BUILDER DECLARATION Estimated valuation42,000.00
I hereby affirm that I am exempt from the Contractors License Law for the following
reason: .(Sec. 7031. 5, Business. and Professions Code: Any city .or county which requires- a
permit to construct after, improve; demolish, or, repair any structure,' prior to Its issuance-also -
requires the appiicant for such permit to rile 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 Processions Code, or that. he is exempt therefrom, and:the basis
for fire alleged exemption. Any violation. of Section 7031.5 by 'any applicant for a .permit Plan Chk. Dep.
subjects the applicant to a civil penalty of not more than rive hundred dollars ($500). -
❑ I, 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 Const.'.
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
or proving that he did not build or Improve./or.the purpose of sale.) .33. 50
❑ 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 S•M.1.
such projects with a contractors) licensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec B.-& P.C. for this reason Grading
Driveway Enc.
Date owner - Infrastructure
WORKERS' COMPENSATION DECLARATION
-I hereby affirm that I hale a certificate of consent to* self•insure,•or a certificate- of
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3600, Labor Code.)..
Policy No. Company
O Copy is filed with the city. ❑ Certified copy.is hereby furnished.
TOTAL 33.50
CERTIFICATE OF EXEMPTION FROM REMARKS
WORKERS'COMPENSATIONINSURANCE
(This section need not be completed if the permit is for, one hundred flars ($100) valuation - - - -
or less.) ' ,,+ - „�' ,
I certify that in the performance of the wdrk for which this permit is issued, I shall not
employ any person in any manner so as tofbecome subJec to'the Workers' Compensation
Laws.of,Calitocnla.
Date vim' %� Owner A0
soT10E TO APPLICANT: Ir, after making this Certificate of Exemption you should become ZONE: - BY:
subject to the Workers' Comp sation provisions of the Labor Code, you must -forthwith
comply with such provisions or this permit shall be deemed revoked. Minimum Setback Distances:. -
Front.Setback from ter Li
Rear Set b �gfrom Re�fjop...ine
WARNING: FAILURE TO SECURE WORKERS'COMPENSATIONCOVERAGE 'IS.UNLAWFUL. AND Sid e.Street ackfrom"C ter L'
SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL .FINES UP. TO. ONE" ' .
HUNDRED THOUSAND DOLLARS. ($100.000). IN ADDITION TO THE COST OF COMPENSATION, Side Setback f - Property, '
DAMAGES AS PROVIDED FOR IN SECTION•3706'OF THE LABOR CODE,'INTEREST,-AND n
ATTORNEY'S FEES. V
This is a buildin FINAL DATE
TS TO
"
g peimit 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.. Issued by: Date A Perm _
I agree to comply with all city and county ordinances and state laws. relating'to building j
construction, and hereby authorize representatives •of' this • city to -enter the. above . Validated by:�
mentioned property for Inspection purposes.
Signature of applicant Date n
Mailing Address Validation: `�...-
City, State, Zip
r
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBINU FEES
1ST FL. SQ. FT. ® $
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. SO. FT. ®
GAS (ROUGH)
METER LOOP
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
GAS (FINAL)
TEMP. POLE
DRAINAGE PIPING
CAR P. SQ. FT.
GROUT
WATER HEATER
WALL SQ. FT.
FINAL INSP.
DRINKING FOUNTAIN
SO. FT. ®
WATER SYSTEM
URINAL
ESTIMATED CONSTRUCTION VALUATION $
=$
WATER PIPING
NOTE: Not to be used as property tax valuation
L INS _
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
FIRE ZONE ROOFING
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.
SQ. FT. @ c
BATH TUB
LATHING
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ac
HOUSE SEWER
FINISH GRADING
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
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.
L INS _
FRAMING
FINAL INSP.
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