9658 (ELEC)4
P.O. BOX 1504 No. 9658
Building 78-105 CALLE ESTADO
Address 78039 CALLE ESTADO LA QUINTA, CALIFORNIA 92253
Owner TRASH & ELECTRIC METER
Mailing BILL HOWARD BUILDING: TYPE CONST. UC.E0SWC-& GRP. -
Address A.P. Number
City Tel.
� Legal Description
Contractor
OWNER BUILDER
Address
I
Zip Tel.:
State Lic. City
& Classif. I Lic. #
Arch., Engr.,
Designer
Address FT —el.
City Zip State
I I 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.
DATE
OWNER -BUILDER DECLARATION
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
permit to construct, alter, 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
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
subjects the applicant to a civilpenalty ofnot more than five hundred dollars ($500).
��(as owner of the property, or my employees with wages as their sole compensation, will
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.) .
b 1, as owner of the property, am exclusively contracting with licensed contractors to con-
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 4or
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
0 1 am exempt under Sec.—B. & P.C. for this reason
I I / . .4 A /—,), I I
Idate 6 / _T1 I I Owner IWAIF V I
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
0 Copy is filed with the city. 0 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
or less.)
I certify that in the performance of thip work for which this permit is issued, I bhall not
employ any person in any mannertso as to become subject toAhe Workers' Compensation
Vews I C Ill Y V
?,�e Owner A/1"Vc
NOTICE lTO APPLICANT It, eftei making'this Certificate- of Fx_em'�tion —you should become
subject to the Workers' Compensation provisions of 'the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I = affirm that there is a construction lending agency for the performance of the
work ch this permit is issued. (Sec. 3097, Civil Code.)
Lender's Nam
Lender's Addre
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 car Illy 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—
Maili ' ng Address
City, State, Zip
Project Description
METER (200
TRASH ENCLOSURE & ELECTRIC
AMP)
Sq. Ft.
Size
No. No. Dw.
Stories Units
New 0 Add 0
Alter 0 Repair 0 -Demolition 0
Estimated Valuation
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
$25.00
Mech.
Electrical
33.50
Plumbing
S.M.L�
.10
Grading
Driveway Enc!_
Infrastructure
TOTAL
$58.60
REMARKS
10
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 Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. Fr. @ $
UNITS
A.C. UNIT
2ND FL SO. FT. @
SLAB GRADE
YARD SPKLR SYSTEM
I
POR. SO. FT. @ -
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. @
POWER OUTLET
ROOF DRAINS
fly
SEWER OR SEPTIC TANK
DRAINAGE PIPING
CAR P. SO. Fr. 0
DUCT WORK
ROCKSTORAGE
WALL SO. FT. 0
DRINKING FOUNTAIN.
SO. FT. @
METER L60P
URINAL
ESTIMATED CONSTRUCTION VALUATION $
REINF. STEEL
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICALFEES
WATER SOFTENER
VENT SYSTEM. FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE' DRYER
FINAL INSP.
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
IKITCHEN SINK
ABSORPTION SYSTEM, B.TM.
TEMP USE PERMIT SVC
WATER CLOSET'
COMPRESSOR HP
POLE, TEMIPERM
LAVATORY
HEATING SYSTEM. FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER. B.T.U.
SO. FT. a c
BATH TUB
REMARKS:
SCLFT @ c
WATER HEATER
MAX.,HEATER OUTPUT, B.T.U.
SO. FT. RESID @ 1% c
SEWAGE DISPOSAL
SQ.FT.GAR @ 3/4c
HOUSE SEWER
FIREPLACE
GAS PIPING
PERMIT FEE'
PERM FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE MECHI.FEE
PLCK.FEt
CONST. FEE ELECT.FEE
SMIFEE PLUMB. FEE
STRUCTURE / PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR,
SETBACK
'V
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
fly
SEWER OR SEPTIC TANK
ROUGH WIRING.
DUCT WORK
ROCKSTORAGE
FOUND. REINF.
GAS(kOUGH)
METER L60P
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
yd.
$-Plus-x$-=$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION.
/01 -
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL