003515 (ELEC)TW�t 4 4- Qu "01,241
Building
Address 51-495 Ave• ida Diaz
Owner
mailing
Address P
City
I Contractor
State Lic.
& Classif.
Arch:, Engr.,
Designer
I
Address
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
No. 0035.5
T'^ "raven BUILDING: TYPE CONST. OCC: GRP.-
box
RP.box 381. A.P. Number
Zip Tel.
.92253- . 56&--4354 Legal Description
Project Description 100 AMP
Zip Tel. --
City
Lic. # Sq. Ft. No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Tel.
AMOUNT
CERTIFICATE OF EXEMPTION FROM
REMARKS
City
Zip
State
I
Lic. #
or less.)
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of the Business and Professions Code, and my license is in full force and
effect. . .
SIGNATURE DATE
OWNER -BUILDER DECLARATION
Estimated Valuation
I hereby affirm that I am exempt from the Contractor's License Law for the following -.
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires -a
ZONE:
BY:
permit to construct, alter, 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
PERMIT
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'
• -
for the 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 five hundred dollars ($500).
Plan Chk. Bal.
_ Q 1, as owner of the properly, 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
work for which this permit is issued. (Sec. 3097, Civil Code.)
Professions Code: The Contractor's License Law does not apply to an owner of property who
. ,COr1St.
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' .
Lender's Address
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 improve for the purpose of sale.) _
❑ 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 contractor(s) licensed pursuant to the Contractor's License Law.)
Grading
❑ I am exempt under Sec. B. & P.C. for this reason
construction, and hereby authorize representatives of this city to enter the above-
Driveway Enc.
Infrastructure
Date If Owner - �""9 /
- R
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.) '
Policy No. Company
Mailing Address
❑ Copy is filed with the city. . O Certified copy is hereby furnished.
TOTAL
AMOUNT
CERTIFICATE OF EXEMPTION FROM
REMARKS
WORKERS' COMPENSATION INSURANCE
- (This section need not be completed if 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., If, after making this Certificate of Exemption you should become
ZONE:
BY:
' subject '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 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
Lender's Address
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
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING,rEES
IST FL. SQ. FT. ® $
UNITS
A.C. UNIT
COLL. AREA
SLAB GRADE
YARD SPKLR SYSTEM
2ND FL. SO. FT. ®
HEATING (ROUGH)
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
ROUGH WIRING
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
FOUND. REINF.
GAS (ROUGH)
DRAINAGE PIPING
CAR P. SQ. FT. ®
HEATING (FINAL)
WALL SO. FT. ®
REINF. STEEL
DRINKING FOUNTAIN
SO. FT. @
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
SERVICE
FLOOR DRAIN
MECHANICAL FEES
FINAL INSP.
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
$
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LUMBER GR.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
FINAL INSP.
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
FIRE ZONE ROOFING
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/a c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ac
HOUSE SEWER
GAR. FIREWALL
GAS PIPING
PERMIT FEE
LATHING
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 APPJEQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
FINAL INSP. 2
$
ZGADIN G
cu. yd.
plus x$
_$
LUMBER GR.
FRAMING
FINAL INSP.
ROOFING
Its
DEC
9
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_
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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