002553 (ELEC)P.O. BOX 1504 No... 002553
Bddress %'-3.4.5 Fe�k, f' Rsi 78-105 CALLE ESTADO
LA
Address QUINTA, CALIFORNIA 92253
Owner _ . ., ..., .. _.... .. _ . .. .. .. _ .
swwjxse calpmY
Mailing BUILDING: TYPE CONST:
Address 7505 COUntr�' A.P. Number
City. Zip Tel.
nn�9 . , '- Legal Description
Contractor Project Descriptions -
: Address
OCC;.GRP.•
. City _ .- Zip..
92260... -
State Lic. 3
& Classif: -'444395 '
Arch., Engr .. - .
Designer
Address
Tel.
City
Lic. # Sy y Sq. Ft. No.
Size • Stories
Tel.
LNew.OA Add ❑ Alter ❑ ,::.' Repair ❑.. Demolition ❑ •
City Zip State
Lic. #
' LICENSED CONTRACTOR'S DECLARATION,
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with.Sectior -
7000) Of Divislibn 3 of the Business and Professions Code, and my license is in full -force -and -
a fect..
SIGNATURE Y - DATE
ta• OWNER•BUILDER DECLARATION
Estimated Valuation
I hereby affirm that I am exempt from the Contractor's License Law for the following
m
�`
reason:-(Sec. 7031.5,Business and Professions Code: Any.city or county which requires ar
"
'�i'� '
permit to construct, alter, improve, demolish, of 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 .
- PERMIT
'AMOUNT -
the provisions of the Contractor's License Law, Chapter9 (commencing with Section 7000) or -
' " •'
-
' Division 3 of the Business and Professions Code,' or that. he. is exempt therefrom, and tffi basis
for the Any, Section 7031.5 by 'any-
-
Plan Chk. -Dep.
•'
_• alleged exemption. violation of applicant for a permit
'subjects the applicant to a civil penalty of not more than five hundred dollars ($500):
Plan Bal..
-•
, 0I, as owner of the property, or my employees with wages as their sole compensation, will
-Chk.
do.the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and..•
COf1St.
• 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. If, however, -the building
or Improvement is sold within one year of completion, the -owner-builder will'have the burden
'Electrical
of proving that he did not build or Improve for the purpose of:sale.)
'
'❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-
Plumbing
• Strutt 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.
S.M.I. -
-
such projects with -a contractor(s) licensed pursuant to the Contractor's License Law.)
..
Grading
❑ I am exempt under Sec..B. B. & P.C. for this reason
Driveway Enc.
Date owner
Infrastructure
WORKERS' COMPENSATION DECLARATION "
' f 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
O Copy is filed with the city. , ❑ Certified copy is hereby furnished. .
TOTAL
CERTIFICATE OF EXEMPTION FROM
REMARKS'
- -
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 the 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 this Certificate of Exemption' you should become
ZONE:
- -BY:
' subject to the' Workers' Compensation provisions of 'the Labor Code, you - must'.forthwitn
comply with such provisions or this permit shall be deemed revoked. -
.Minimum Setback'Distances:
Front Setback -from Center..Line
Rear Setback from Rear- Prop.,Une
CONSTRUCTION LENDING AGENCY _.
Side Street Setback from Center Line "
hereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, Civil Code.) -. _
Side Setback from Properly Line
Lender's Name
Lender's Address
DATE
- -" INSPECTOR' '
- This is a building permit when properly filled out, signed and validated, and is subject to"FINAL
expiration if work thereunder is suspended for 180 days. •-. -•
4 _ . :T2-863
'Date
I certify that I have read this application and state that the above information is correct.
' , Issued by:•
Permit
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.:,!may_
1l
Validated by:
Signature of applicant A +�-� �� a j %r ! - �.. f, Date
Mailing Address—1 1' r= " ~-�
Validation:
City, State, Zip 3�
Ab 2.73.......9..
2
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO . PLUMBING FEES
1ST FL. SQ. FT. ® $
2ND FL. SQ. FT.
POR. SQ. FT. ®
GAR. SQ, FT. ®
CAR P. SQ. FT.
WALL SO. FT. ®
SQ. FT. ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
BONDING
FLOOR DRAIN
MECHANICAL FEES
FORMS
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APP.IEOUIP.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
TEMP. POLE
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
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/a c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ac
HOUSE SEWER
REMARKS:
VENTILATION
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.IEOUIP.
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
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
1 UM'J WUNA 1 UNLZRINI I IALS
GARDEN WALL FINAL