03905 (ELEC)tswlaing
Address
Owner
Mailing
4
P:O. BOX 1504
78.105 CALLE ESTADO
AS -801 PA ne Road' LA QUINTA, CALIFORNIA 92253
Fa He
City Zip Tel.
Ira opinta 4225
Contractor
onn®r/milder
Address
State Lic.I City
&.Classif. Lic. M
Arch., Engr., .
Designer
Address Tel.
City I
Zip ' IState
Lic. N
LICENSED CONTRACTOR'S DECLARATION
I herebyy affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000it. .of Divislon 3 of the Business and' Professlone.Cods, and my license is in full force and
effec
aGNATl1RE DATE
OWNER•BUILDER DECLARATION
I hereby affirm that'I am exempt from the Contractors License Law for the following
reason: (Sec. 7031.5,Busfness and Profeaskxu Cede: Any city w county whk4r repukes a
permn to construct, atter, Improve. 0engnah, or repah any etnpture, Drla lo its Isauarrcb sten
regriliss the eppiteant lot -such permq ro 81a a signed atatemMt t/at he Is scenaed purausnr to
the provlalons o! the Contreclor's Lloense Law, Chapter 8 (comnrerrdnp wIM Section 7000) of
t>ivlslon 3 0l. the 8uslnese end Pro/esaions Code, or Mer. he !s exempt therefrom, and Me basis
/or rhe elk+ped exemption. Any'vloletlon.o/ Sectkxr 7091:5 Dy any appfkant Ibr a permit
subjects the'appllcant to a cin/ penaity o/not more than flue Iwndred dagars (i'b00):
❑ 1, 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. (See. 7044, Buisness and
Professions Code: The Contractor's License Law does not apply to' an owner o/ property who
builds or knproves 'thereon and who does such work himself or through his .own employees,
provided that such Improvements are not Intended or offered for sale. N, however, the.building
or Improvement is sold within one year o/ completion, the owner-butlder will have the burden,
of proving that he didnot build or Improve 'for the pu)pose of sale.)
O I, as- owner of,the property, am exclusively contractingwith licensed contractors to coo-
struct the project (Sec. 7044:. Buslness and Profesabns Code: The Contractor's License Lew
does not apply to an owner of property who builds or knproves thereon, and who contracts for -
such projects with a contractor(s) licensed pursuant to the.Contractora License Lew.)
O I am exempt under Sec. .^ S..S P.C. for this reason
Date L'L !' Owner "2' •./ j ; „ y, ?
J _
WORKERS' COMPENSATION DECLARATION
I hereby affirm that'1 have a certificate of consent to self -insure, or a certificate of
Worker's Compensation Insurance, or certified copy thereof. (Sec.4800. Labor Code.)
Policy No. Company
0 Copy Is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed n the permit is for one hundred dollars ($100) valuation
or less.)
1 certify that In the performance of,thg 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 Mls Certificate o/ Exwnj;on you should become
subject to the Workers' Compensation provisions of the Labor' Code, you must forthwith
comply with such provisions or this Permit shag be downed revoked.
CONSTRUCTION LENOING,AGENCY
1' hereby affirm thaYthere Is a coneWction lendlnp agency for the performance of the
work for which this permit is issued. (Sec. 3097, Clog Cods.)
Lenders Name
Lenders Address
This Is abuilding permit when properly filled out, signed and validated, and is subject to
expiration If work thereunder is suspendad,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 Data
Mailing Address
city, state, Zip
NG:" -TYPE CONST. OCC. GRP
Number ! i,%r
y Y -
Project Description
Electrical Pole
Sq. Ft.
Size
No. No. Dw.
Stories Units
New ❑ Add ❑
Alter ❑ Repair ❑ Demolition ❑
EstimatedValuation
c, :•..
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
$20.00
Plumbing
S.M.I.
Grading
Driveway'Enc.
Infrastructure
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 DATEI SPECTOR
4%24/98
Issued by: Date Permit
Validated by:
Validation:
WHITE'- FINANCE, PINK - APPLICANT,,GREEN BUILDING, GOLDENROD -,ASSESSOR'S OFFICE, HARD COPY - FILE
CONSTRUCTION ESTIMATE
t . No. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL SO Fl (p S.
UNITS
:CGLLAREA q --.i
SLAB GRADE
ROUGH PLUMB
YARD SPKLR SYSTEM
2ND FL SO FT. a
HEATING (RdUWHj,
-STORAGE 'TANK'
MOBILEHOME SVC.
BAR SINK
POR SO FT. Cr
DUCT WORK
-w.
POWER OUTLET
ROOF DRAINS
GAR SO. FT. Cr
HEATINGIFINAL)�,•
OTHER-`APPJEQUIP.-l'�
DRAINAGE PIPING
CAR P. SO FT. a
POLE
DRINKING FOUNTAIN-,
WALL—. FT. 0
WATER HEATER
SERVICE
SO. FT. 6
FINAL INSP.
URINAL
"ESTIMATEDFCONSTRUCTION VALUATION t
BOND BEAMWATER
WATER PIPING
NQjE,.Aq!_Io be. q -d w PQpefty
FLOOR DRAIN
MECHANICAL FEES
'TUMBEk GR.
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTOXDISHI
APPLIANCE' DRYER
Rb6flWi57
GARBAGE, DISPOSAL
FURNkCE,..UNIT -,__ FLOOR,
REMARKS:
LAUNDRY TRAY
AIR HANDLING UNIT CFM
KITCHEN SINK
AWdFWPi;i6W*'§��t.E14*---'--'---'--
TEMP USE PERMIT SVC
WATER CLOSET -
COMPRESSOR HP
POLE. TEM/PERM
LAVATORY
Hl�AYINq"SyS7M----- FORCED GRAVITY'
AMPERES SERV ENT
SHOWER
BOILER' B.T.U.BATH
SO. FT. c
TUB
SO. Fr. c
WATER HEATER
MAX HEATER OUTPUT, B.T.U.
So. FT. RESID 6 1% c
SEWAGE DISPOSAL
•
. ....
SO.FT.GAR C -%c
HOUSE SEWER
PIPING IP NG
GA, . _
PERMIT FEE
PERM FEE
P
PERMIT FEE-
Et
DBL----
TOTAL FEES--
- MICRO FEE
MECH.FEE L.CKJFEE
CONST. FEE ELECT. FEE
SMI FEE' PLUMB'FEE
-STRUCTURE-- PLUMBING ELECTRICAL HEATING & AIR'COND. -SOLAR
- I - - . i -,.
�.A-V�IQ UQ R All 0 j0:,.)
PLUMBING
-UNDERGROUND.
A.C. UNIT
:CGLLAREA q --.i
SLAB GRADE
ROUGH PLUMB
HEATING (RdUWHj,
-STORAGE 'TANK'
-FORMS
SEWER OR -SEPTIC TANK
ROUGH WIRING
DUCT WORK
-w.
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATINGIFINAL)�,•
OTHER-`APPJEQUIP.-l'�
•-REINFrSTEEL
GAS (FINAL)
POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAMWATER
SYSTEM
GRADING
cu. yd.
21
'TUMBEk GR.
FINAL INSP.
..FRAMING-
FINAL INSP.
Rb6flWi57
0A
b, &i
j
REMARKS:
VENTILATION
FIREPLACE
--SPARK--ARREST0R--
GAR. FIREWALL
LATHING
MESH:
jlhls7uL�AjIONISOUND
71777-7u,,�".
•
. ....
INSPECTIONFINAL
vji-- 14
INSPECTORS SIGNATUREVINITIALS
GARDEN WALL FINAL
- I - - . i -,.
�.A-V�IQ UQ R All 0 j0:,.)