10307 (ELEC)TAtyl 4
P.O. BOX 1504
Building 7$_,705 `7ILLETA LA QUINTA, CALIFORNIA 92253
Address
CENTURY HOMES
Mailing
Address 1535 SO. "Difs ST
City _ Zip TIiId
SAN BERNARDIN0 92412 1370-3001
Contractor
TE14PORARY UTILITY SERVICES
Address
1372 VALENCIA
Gity Zip Tel.:
SANTA A14A 1.92680 14-358-0814
State Lic. City
& Classif. 523596 v-61 Lic. #1881
Arch., Engr.,
Designer
Address Tel.
City Zip State
Lic. #
v LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licer•ed under provisions of Chapter 9 (commencing with Section
7000) of Divisi6n;3 of the Busiress and .Professions Code, and my license is in full force and
effect. ; .�it%�",,•�,�.�.�-�. r s:;r
SIGNATURE IV DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractors License Law for the following
reason: (Sec. 7031.5,Business ;and Professions Code: Any city or county which requires a
permit to construct, alter, fmprooa, 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
the provisions of the Contractor'. License Law, Chapter 9 (commencing with Section 7000) o/
Division 3 o/ the Business and Pofessions Code, or that. he is exempt therefrom, and the basis
for the alleged exemption. Any violation o/ Section 7031.5 by 'any applicant for a permit
subjects the applicant to a civil penally o/ not more than five hundred dollars .($500).
❑ 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. I/, however, the building
or improvement is sold within oee year of completion, the owner-buyder will have the burden
of proving that he did not build or improve for the purpose of sale.)
O I, as owner of the property, am exclusively contracting with licensed contractors to con-,
slruct 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
such projects with a contractor(s) Licensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec. B. 8 P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION . . '
I hereby affirm that I ha•e a certificate of consent to self -insure, or a certificate of
Worker's Compensation Insurance, ora certified•oopy-thereof. (Sec. 3800, Labor:Code.)
Policy No. };ompany.
O Copy is filed with the cit:'. , ❑ Cerlified�copy is hereby furnished.
CEOTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be comrleted if the permit is /or one hundred dollars ($100) valuation
or less.)
I certify that in the pertornance of thg work for which this permit is issued, I shall not
employ any paon in any manner so as to become subject to the Workers' Compensation'
Laws of
Cal ifornirsa.
Date - Owner
NOTICE TO APPLICANT: If, aiter making this Certificate of Exemptfon you should become
subject to the Workers' ' Comt•ensatfon provisions of the - Labor Code, you must forthwith
comply with such provisions or the permit shall be deemed revoked. -
CONSTRUCTION LENDING AGENCY
I hereby affirm that there s a construction lending agency for the performance of the
work for which this permit is is.ued. (Sec. 3097, Civil Code.) .
Lender's Name
Lender's Address
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 certify that I have read this.application and state that the above information is correct.
I agree to comply with all cit} and county ordinances and state laws relating to building
construction, and hereby autGorize representatives -of, this city to enter the above-.
mentioned property for inspect�on purposes.
Signature of applicant Date
Mailing Address
City, State, Zip
BUILDING: TYPE CONST
P. Number
No. 10307
OCC: GRP.
Legal Description
Project Description TEMP POWER POLE
Sq. Ft. No. No. Dw.
Size Stories Shits
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation $250
PERMIT AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech. _
Electrical $ 30. UO_
Plumbing r
S.M.I.
Grading
Driveway Enc.
Infrastructure
txnC' �r� n{,4 t �S
;i ca v -.r "Als+ t l If i j Lw'I _.. ' , v . QQ
TOTAL $250
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 Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
SLAB GRADEIYA
2ND FL. SO. FT.
BO NG
YARD SPKLR SYSTEM
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SO. FT.
FOUND. REINF.
DRAINAGE PIPING
WALL SO. FT.
METER LOOP
DRINKING FOUNTAIN.
SO FT ®
REINF. STEEL
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
WATER HEATER
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
LUMBER GR.
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
FRAMING
LAUNDRYTRAY
AIR HANDLING UNIT CFM
ROOFING /L
•'l
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
FIREPLACE
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1 Vi 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
1 1
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADEIYA
ROUGH PLUMB.
BO NG
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC
ANK
UGH WIRING.
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE ! < C
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING /L
•'l
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