05632 (ELEC)TA
P.O. BOX 1504 N 0'5632,
Building 54—,139, $OUB HMS 7&105 CALLE ESTADO '
AddressLA QUINTA,:CALIFORNIA.92253.. t . .
Owner,1.
S i e'.. Deiert Partners ;.
•-" * �" " BUILDING: 'TYPE'CONST. 'OCC: GRP.
Mailing + • -
Address 75-005Country Cluh fir.
CityZip Tel. x- i
�al;n 92260 tail TRACT #22��2�3
Legal Description
Contractor. Project ®IAEA EL�ia DQE U.
�O
,tt:tt3l. vart;tEsd Laud 'CO. ProjectDescription Y
Address
eme
City Zip Tel_" ..,.
Sam �� I
State Lic.' City
& Classif. 288130 Lic. #
Arch., Engr.,
Designer
Address- Tel.
7 W Sq. Ft. ,
Size
v �• New 1@
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�o�/ft/he Business and Professions Code,.amrd my license is imfull force and
-effect. - � � � S f : r � ✓("��,%' " I''
SIGNATURE d .A DATE
OWNER -BUILDER DECLARATION .
I hereby affirm that I am exempt from the Contractors License Law for the following
reason: (Sec. 7031.5,8usiress and Professions Code: Any city of county which requires a.
permit to construct, alter, improve, demolish, or repay any sbuchoe,- prior to its issuance- also
requires the applicant for such permit to Me a signed statement that he is licensed pursuant to
the provisions of the Contractor's License law, Chapter 9 (corm&-xwV 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 Sewn 7031-5 by •'arty appli and for a permit
subjects the applicant to a civil penally of not more Man five hundred dolts (5500). ,
❑ 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, Buismess and
Professions Code: The Contractor's license Law does not appy to an owner of property who
builds or improves thereon and who does such work himself or through his own employees;
'provided that such improvements are not.bdended or offered for safe. fl, however, the budding
orimprovem ent is sold wither one year of completion, the owner-0railder wit have the burden
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-
struct the project. (Sec. 7044, Business and Professions Code: The Certractors license law
does not apply to an owner of property who builds or improves thereon, and who conhacts for
such projects with a contractor(s) licensed pursuant to the Contractors License Law.)
❑ I am exempt under Sec. R. & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
_ I hereby affirm that I have a certificate of ,consent to self -insure, or a certificate of
Workers Compensation Insurance, or a certified copy thereof. (Sec- 3800, Labor Code-)
Policy No company�r�C$ h,r
❑ Copy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATEOF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need of be completed it the permit is for one hundred doders (S 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 Cabfornia.
Date Owner
- NOTICE TO APPLICANT: ff, after maiming this Certdcate of Exemption you should become
subject to the Workers' Compensagan provisions of the Labor Cade• you must forthwith '
comply with such provisions or this permit shat be deemed revoked. -
CONSTRUCTION LENDING AGENCY
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-) ,
Lenders Name"
Lender's Address
This is a building ut, permit when property filled osigned and validated, and is subject to
,expiration if work thereunder is suspended for 100 days. - - '
I certify that I have read this application and state that the above information is correct.
I agreeto 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 '
City,. State, Zip
No.' No. Dw.
Stories Units: --
Add, ❑ .. Alter ❑ Repair ❑ 6 Demolition ❑
TOTAL - _ lc� i -
REMARKS' 4 nt
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line '
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE INSPECTOR • ' a
" 412/89 h
Issued by: ! Date Permit,
Validated by:
Validation: _a
P
Estimated Valuation
PERMIT
`AMOUNT'
Plan Chk. Dep.
Plan. Chk. Bal.
Const.
a ,.
Mech.'.
Electrical
Plumbing
'
S.M.I.
-.
Grading.
Driveway Enc.
Infrastructure
TOTAL - _ lc� i -
REMARKS' 4 nt
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line '
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE INSPECTOR • ' a
" 412/89 h
Issued by: ! Date Permit,
Validated by:
Validation: _a
P
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. 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
HEATING (FINAL)
POWER OUTLET
ROOF DRAINS
GAR. SO. FT. ®
TEMP. POLE
GROUT
DRAINAGE PIPING
CARP. SO. FT. ®
FINAL INSP.
BOND BEAM
WATER SYSTEM
DRINKING FOUNTAIN.
WALL SO. FT.
=$
LUMBER GR.
FINAL INSP.
URINAL
SOFT ®
ROOFING
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
VENTILATION
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FIREPLACE
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, 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 Vi c
SEWAGE DISPOSAL
SO.FT.GAR ® V4c
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
ICEla
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
FIN!GRADING 4 If
NAL INSPECTION lQ .
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
1