002090 (ELEC)4
P.O. BOX 1504 Mi. 002090
Building 7&105 CALLE ESTADO
Address 48-100 EE&2fthMMr LA•QUINTA, CALIFORNIA 92253
Address 74--1
City
Palm Da
Contractor
Address
La t
State Lic.
& Classif.. j
Arch., Engr.,
Designer
Address
City
Zip
92260 1
Tel:
56d-26004
City
Lic. #
Tel.
Zip State
I.Lic. #
BUILDING: TYPE CONST. . OCC: GRP.-
A.P. Number
Legal Description
Project Description UMM zaq a2 s
Sq. Ft: No. No. Dw.
Size Stories Units
New IR Add ❑ Alter ❑ Repair ❑ - "Demolition ❑
I hereby affirm that I am licensed`uriEer oioviaiona of Chapter 9 (commencing with Section :.
7000) of, DIsion 3 of he Business and Prokq sions Code and my Iic se is In ful�'Epr a ark F
effect. -'�.; % ' �r
�
/'� � �l+n i ��Vt.'31�;�jY,-► .:01,x:; <<; �f
_
SIONAT t.� - - DATE
TOWNER•• UIkD DECLARATION
��
I hereby affirm that I am exempt from th8^Contractor's License Law for. the following
Estimated' Valuation
reason: '(Sec. 70Z11.5,Bgs1nssa and .Professions Code: Any city or. county which requires a -
permit to construct, alter, Improve, demolish, or repair'. any structure, prior to its issuance also
requires the appgcarmt_:for such permit to file a signed stetement,that, he /s licensed pursuant to.
_
PERMIT AMOUNT
the P.I.I.a of the Contractor's License Law, Chapter9 (commencing with Section 7000) of
.Division 3 of the Business and Professions Cade, or'that; he'is exempt therefrom, and the basis
for the Section 7031.5 by any for. -a
Plan Chk. Dep.
alleged exemption. Any violation of applicant perm.
subjects thwapplicant to a civil penalty of not more than Ove hundred dollars ($SOO. - .
- -
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
COriSt. - '
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,
" McCh. -
provided that'such Improvements. are not' Intended or offered for sale. 9, however, the,bullding
.or Improvement is -sold within one year of completion, the owner -builder wig have the burden
Electrical qua
1 f M 0v
. of proving that he did, not.bulld or. Improve for the purpose ofsale.)
- o
❑ 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
-who
-
does not apply to an owner of property who builds or improves thereon, and. contracts for
S.M.I. - - - - -
such projects with a contractors) licensed pursuant: to they Contractor's License Law.)
Grading '
❑ 1 am exempt under Sec. B. & P.C. for this reason
Driveway Enc.
Date owner
Infrastructure
WORKERS' COMPENSATION DECLARATION
' 1 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
❑ Copy is filed with the city. ❑ Certified copy is hereby furnished.
TOTAL 1.` 0.00
CERTIFICATE OF EXEMPTION FROM
REMARKS.
WORKERS' COMPENSATIOWINSURANCE
(This section need not be. completed If the permit is for one hundred dollars ($700) valuation
-- -
or less.) - -
I certify that in the performance of the work for which this permit is issued, 1 shall not
employ any pparson in any mannenso as to become subject to the Workers' Compensation
Laws of Calmf0 nla.
"Date Owner
NOTICE TO APPLICANT: O, 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'
1 hereby affirm thatthere'is a construction lending agency for the performance of the
work for which this permit is Issued. (Sec. 3087, Chltcods.)
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 It work thereunder Is suspended for 180 days.
I that I have Information is
2r __Fie�
Date t,—Permit
certify read this application, and state that the above correct.
ISSUed.by,:.
I agree to comply with all city and county, ordinances and statelaws relating to building
construction, and, hereby, authorize representatives -of this city to enter the above-
mentioned property for lhipectioo purpose
i
Validated by:
w
Signature- fap Ilcant- �'`;� . ,f" 1 .:r Date F/ •` n.�
Mailing Address i`• i
Validation.
City„ state, .Zip I-
A -44.28 2 26 (7a00 U
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
SLAB GRADE
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL SQ. FT. @
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. SD. FT. ®
GAS (ROUGH)
METER LOOP
GAR, SQ. FT. @
POWER OUTLET
ROOF DRAINS
GAS (FINAL)
TEMP. POLE
DRAINAGE PIPING
CAR P. SO. FT. ®
GROUT
WATER HEATER
WALL SQ. FT: ®
FINAL INSP.
DRINKING FOUNTAIN
SQ FT ®
WATER SYSTEM
URINAL
ESTIMATED CONSTRUCTION VALUATION $
_$
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISHj
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
I LAUNDRY TRAY
AIR HANDLING UNIT CFM
FIRE ZONE ROOFING
KITCHEN SINK
ABSORPTION SYSTEM . B.T.U:
TEMP USE PERMIT SVC
WATER CLOSET"
COMPRESSOR HP
POLE, TEWPERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SQ. FT. ® c
BATH TUB
LATHING
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/, c
SEWAGE DISPOSAL
SQ.FT.GAR ® V.c
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 APPJEQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu..yd.
3 plus x$
_$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
NAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS,
GARDEN WALL FINAL