14579 (ELEC)_ P.O. BOX 1504
Building 455-00551 Desert Air St. LA QUINTA, CALIFORNIA 98-495 CALLE 2
Address 253
Owner
Can, fury Homes
Mailinga
Address 2535 South DN St. S3Uite 200
i City Zip Tel.
Saga Bernardino CA 92 38 (9.09)381-0041
Power
Contractor
Address.
2720 E. Hegar. Park Dr.
ti" hiem, CA 1"p 92806 .00) 863-2525
State Lic. City
& Classif.. C-10 523596 Lic. #
Arch., Engr.,
Designer
Address Tel.
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I,a aicensted under provisions of Chapter 9'(commencing with Section
7000) of Di�vis�ion 3 of
th�etBu3in ss and Professions Code, and my -license is�,full.force'and .
��%�.[.>�v�
SIGNATURE —"' B —� r DATE
OWNER -BUILDER DECLARATION '
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
No. 14579
BUILDING: TYPE CONST. OCC. GRP.
A.P. Number
Legal Description
(Project Description• 200 Mp Temp. Meter Power
Pole
Sq. Ft. No. No. Dw.
Size- Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation $350.0€
permit to construct, after. Improve, demolish, or repair any structure, prior to its issuance also
requires the applicant 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 Professions Code, or that. he Is exempt therefrom, and the basis
Dep.
for the alleged exemption. Any violation of Section 7031.5 by 'any applicant for a permit
Plan Chk.
subjects the applicant to a civil penalty of not more than rive hundred dollars ($500).
Plan Chk. Bal.
❑ I, as owner of the property, or my employees with wages as their sole compensation, will
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and: •
Const.'.
Professions Code: The Contractor's License Law does not apply to an ownerof property who
builds or Improves thereon and who does such work himself or through his own employees,
Mech.
provided that such Improvements are not intended or offered for sale. If, however, the building
or improvement is sold within one year of completion, the owner -builder will have the burden
Electrical
'
of proving that he did not build or knprove for the purpose of sale.) -
O 1, as owner of the property, am exclusively contracting with licensed contractors to con-
Plumbing
struct the project. (Sec. 7044, Business and -Professions Code: The Contractor's License Law
does not apply to an. owner of property who builds or Improves thereon, and who contracts for -
S.M.I.
such projects with a contractor($) /icensed pursuant to the Contractor's License Law.)
-
Grading
❑ I am exempt under Sec. B. 8 P.C. for this reason
Driveway Enc.
Date Owner
Infrastructure
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I 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.)
Po�l01
icCompany
LCl Copy is filed with the city, ❑ Certified copy is hereby furnished. •
TOTAL
CERTIFICATE OF EXEMPTION FROM
REMARKS
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars -($100) valuation
C.a �•/
"'or less.)
� yy
I certify that in the performance of the work for which this permit is issued, I shall not
t'; A 1
'employ any person in any manner so as to become subject to the Workers'. Compensation4
Laws of California.
r Y F r
( , j �+
Date Owner
1
�t Asubject
NOTICE TO APPLICANT: ft, after making this Certificate of Exemption you should become
ZONE:
BY:
to the Workers' Compensation provisions of the Labor Code, you must forthwith�•
comply with such provisions or this permit shall be deemed revoked.
Minimum Setback DlStanCeS: q j
Front Setback from Center Line '
Rear Setback from Rear Prop. Line
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND'
Side Street Setback from Center Line '
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 from Property Line
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND
-
ATTORNEY'S FEES.
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.
I certify 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
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBINU FEES
1ST FL. SO. FT. p $
UNITS
SLAB GRADE
2ND FL. SO. FT.
BONDING
YARD SPKLR SYSTEM
STORAGE TANK
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
DUCT WORK
ROCK STORAGE
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
HEATING (FINAL)
OTHER APP./EOUIP.
DRAINAGE PIPING
CAR P. SO. FT.
TEMP. POLE
WALL SD. FT.
GROUT
DRINKING FOUNTAIN
SO. FT. ®
FINAL INSP.
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER SYSTEM
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
FRAMING
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
REMARKS:
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
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 ® 114 c
SEWAGE DISPOSAL
MESH
SO.FT.GAR ® 3/<c
HOUSE SEWER
INSULATION/SOUND
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 APP./EOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
FINAL INSP.
GRADING
cu. yd.
$ -Plus-X$-=$
LUMBER GR.
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 SIONATURESIINITIALS
GARDEN WALL FINAL