14370 (ELEC)I
TAiyl
44
f�`�GH,rGv
P.O. BOX 1504 No. 14370
Building 50-503 Jefferson St. 78-495 CALLE TAMPICO
Address LA QUINTA, CALIFORNIA 92253
Rancho Capistrano Corp.
Address
City Zip Tel.
. V4 (Juinta.o... ; 92,2S3'
Co'e •9$ectric inc.
Abid es
rV-49'4 Leman Plaade Stib. 'G -i
City Zip Tel.:
Palm Desert, 92260 341--0036
State Lic. 197002 City 79
& Classif.. Lic. #
Arch., Engr.; '
Designer
Address Tel.
City Zip State
Lic. #
LIGENSERUNTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
000)
,of
of Division 3,`o�f the BusinesgYs and Professions Code; and my license is in full force and
. ffec� �l.if)'f�•' F,_-1 �r fi.^'''�.'..,..» .
SIGNATURE i DATE
OWNEWBUILDER DECLARATION
I he @@by affi that L am exempt from the Contractor's License Law for the following
reason: (S ec.,7031.5,Sustness and Professions Code%Any, city or county. which requires, a
permit to construct, atter, 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 -
the provisions of the Contractor's License'Law, Chapter 9 (commencing with Section 7000) of
Division 3 of the "Business and Professkins 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
subjects the applicant to a civil penalty of not more than Ove hundred dollars ($500).
O 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, Suisness and
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,
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
of proving that he dM not build or improve./or the purpose of sale.)
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-
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
such projects with a contractors) (fcensed pursuant to the Contractor's License Law.)
❑ 1 amiexempt under Sec. B. & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
'1 hereby affirm that I have a certificate of consent to self -insure, or a certificate of
Worker's Co nsation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
PolCop
, .Company
Copy is filed with the.city, .O Certified copy is hereby furnished:
CERTIFICATE OF EXEMPTION FROM
t WORKERS' COMPENSATION JNSU RANCE
(This section need not be completed ff. 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: O, alter making this Certificate of Exemption you should . become
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked. • .
9
f
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND
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,
DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOR CODE; INTEREST, AND
ATTORNEY'S FEES.
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 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
City, State, Zip
BUILDING: TYPE CONST: OCC: GRP:
Number
Legal Description
Project Description Temp. Power for�:�,L' bhou.�ae
Sq. Ft. No. No. Dw.
Size- Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ -Demolition ❑
Estimated Valuation $1000.01D
PERMIT AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.-
Mech.
OnSt.Mech.
'! A
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
1 A
TOTAL
REMARKS
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback fror
�tyenlerLine
Side Setback from Ij
FINAL DATE I CTOR1
Issued by: Dat Perr
i'
Validated by: �y `�
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBINU FEES
IST FL. SO. FT. @ $
2ND FL. SQ. FT. @
POR. SO. FT. @
GAR. SQ. FT. @
CAR P. SQ. FT. @
WALL SQ. FT. @
SO. 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.COOL 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'
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
L INSP.
SQ. FT. @ c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID @ t Va c
SEWAGE DISPOSAL
SQ.FT.GAR @ 3/ac
HOUSE SEWER
VENTILATION
GAS PIPING
PERMIT FEE
FIRE ZONE ROOFING
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 APPJEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE'
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATERSYSTEM
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
L 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