002874 (ELEC)P.O. BOX 1504 No. 002874
Building n 78-105 CALLE ESTADO
Address 54" 365 �'�� --k%T m LA QUINTA, CALIFORNIA 92253
Owner
Dave F 081,E F
_ BUILDING: TYPE CONST. OCC: GRP.
Address 54_43!;M41M1101W
City Zip Tel.
rA Quint .923
Contractor
Address
city D--Wxt zip 92M Tel. Palm 345-0113
State Lic. City
& Classif. 501804 Lic. # applied
Arch., Engr.,
Designer
Address Tel.
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 of the Business and,Professions Code, and my license is in full force and
effect.r.r
DATE
OWNER -BUILDER DECLARATION
I hereby.affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 703.1.5, Business and. Professions Code: Any city or county which requires a
I permit to construct, alter, improve, demolish, or repair any structure, pdor4c, its issuance also
requires theapplicantfor such permit to file a signed statement that he is licensed pursuant to
i the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Division 3 oftheBusiness 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
subjects the'applicant to a civil penalty of not more than rive hundred dollars ($500).
1 p 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
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 did.not build or improve.for the purpose of sale.)
❑ 1, as owner of the property, am exclusively contracting with licensed contractors to con-
struct the project. (Sec. 7044, Business and Professions Coder 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 contractor(s) licensed pursuant to the -Contractor's License Law.)
O 1 am exempt under Sec. B, & 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
j Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
i Policy No. Company
.0 Copy is filed with the city. O Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
.WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100) valuation
i or less.)
I certify that in the performance of lhg 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 - Owrier
NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become
subject to the Workers' Compensation piovision's of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked. '
CONSTRUCTION LENDING AGENCY
I hereby affirm lhat'there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, Civil Code.)
Lender's Name
Lender's Address
This is's 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 f
City, State, Zip )
A.P. Number
r
Legal Description
Project Description
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Sq. Ft.
-Size .
No. No. Dw.
Stories Units
New ❑ Add ❑
Alter ❑ Repair ❑ Demolition ❑
Electrical
Plumbing
INSPECTOR
S.M.I.
-
Grading
Driveway Enc.
Validation:
Estimated Valuation
A7189
HARD COPYI
T
_. PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
INSPECTOR
S.M.I.
-
Grading
Driveway Enc.
Validation:
Infrastructure
A7189
1 29 20.00 U
TOTAL
20.00
REMARKS -
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
Issued by:
Date 3.-- Permit
Validated by:
Validation:
A7189
1 29 20.00 U
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
A.C. UNIT
COLL. AREA
SLAB GRADE
YARD SPKLR SYSTEM
2ND FL. SQ. FT. ®
BONDING
HEATING (ROUGH)
MOBILEHOME SVC.
BAR SINK
FOR. SQ. FT. ®
ROUGH WIRING
GAR. SO. FT. ®
POWER OUTLET
I ROOF DRAINS
FOUND. REINF.
GAS (ROUGH)
DRAINAGE PIPING
CAR P. I SQ. FT. ®
HEATING (FINAL)
WALL SO. FT. ®
REINF. STEEL
DRINKING FOUNTAIN
SQ FT ®
TEMP. POLE
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
FINAL INSP.
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
$
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LUMBER GR.
LAUNDRYTRAY
AIR HANDLING UNIT CFM
FRAMING '1 7-0'
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
FIRE ZONE ROOFING
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ac
HOUSE SEWER
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./EQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
$
GRADING
cu. yd.
plus x$
=$
LUMBER GR.
FINAL INSP.
FRAMING '1 7-0'
FINA ,INSP.
ROOFING
0j,/ T 0 wtiA P
•�_�„ ...
(/rim
till
4-�o-a � �
DEC 17. ivy,
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
�
RING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS,
GARDEN WALL FINAL