002507 (ELEC)P.O. BOX 1504 40 002507
Buildingr� 7&105 CALLE ESTADO'
Address 301 ale � LA QUINTA, CALIFORNIA 92253
�
Owner
Mailing " BUILDING: TYPE CONST.- OCC. -GRP.-
Address 7 s«t3n ii Milk
'"k'$iTic•+ A.P. Number. _
City Zip Tel.
Talm .nowrt 92260_,%87-2328 - Legal Description
Contractor y,l g� ,� �,, Project Description'
.Address
sam
City Zip.' Tel.....:... .
' State Lic.
City
& Classif. 288130
Lic. #
Sq. Ft:
No. No..Dw.
size..
Stories Units '
Arch., Engr.; _ _ .._ _ _ _ .
Designer
New.9- Add ❑
Alter ❑ . - Repair ❑ Demolition ❑
f - Address
Tel.
City
Zip
State
_ ...
Lic. #
1.00 $ reft
LICENSED CONTRACTOR'S DECLARATION :.
`
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6 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
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effect.� ..?.i ::err" �.'�.•r '''"/ � .�,G� g.:.
SIGNATURE 4k_a w✓_,_ �. •�_�„ ., ..r - - DATE .
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.. . .
t. ..... OWNER -BUILDER DECLARATION
Estimated Valuation—
I hereby affirm'that I am exempt from the Contractor's License Law for the -following
•, �+
reason:
reason: (Sec. 7031.5,Business, and Professions Code:. Any city or,counly which. requires. -a
permit to construct, alter, improve, demolish, or repair:any structure, prior to -its issuance also
_. - _ - -- •%r
requires the applicant'forsuch permit to file a signed statement that* he is licensed pursuant to
• PERMIT -
AMOUNT <
• 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 therefioin, and the basis .
for the" alleged exemption. Any violation of Section 7031.5 by 'any applicant for a . permit
-.Plan - Chk.. Dep..
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' subjects the applicant to a civil penalty of not more than five hundred dollars'($500). ,-
• .Plan Chk. Bal..
'
O I, as owner of. the property, or my employees with wages as their sole' compensation, will
do the work; and"the structure is not intended or offered".for sale. (Sec. 7044, Buisness and,
COrI$t..:
'
.Professions Code: The Contractor's License Law does not apply,to an owner of property who
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builds .or improves thereon and who does such -work, himself or ,through his own employees,
Mech..
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
22.50
of proving that he. did not build or improve for the purpose of sale.) _ . . _- ..
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❑ 1, as owner of the property, am exclusively contracting with licensed contractors to con-
Plumbing
slruct the project. (Sec. 7044, Business and Professions Code: The Contmctor's'License Law,
does not apply to an owner of property who builds or improves thereon, and who contracts for
S•M.1.•-
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
- -
Grading
❑ 1 am exempt under Sea B. & P.C. for, this reason
Driveway Enc.
Date Owner
Infrastructure
WORKERS' COMPENSATION DECLARATION
' I hereby affirm that I have a certificate'of'consent'to selfAnsure, 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.,
TOTAL
CERTIFICATE OF EXEMPTION FROM
REMARKS
WORKERS' COMPENSATION. INSURANCE '
.
(This section need not be completed if the permit is for one hundretl dollars ($100) valuation
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.. . or less.) _ .. _ _ .. .
,
I certify that in the performance of the work for which this permit is issued, I shall not
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employ any person in any manner so as to become subject to the Workers' Compensation
Laws of California.
Date Owner
- NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become
'-ZONE:
' "subject to the Workers' Compensation provisions of -the Labor 'Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked. -
—BY:,
_Minimum Setback Distances`
Front Setback from Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY
Side Street Setback from Center Line '
f hereby affirm that there is a construction lending agency for the performance of.the
'work for which this permit is issued. (Sec. 3097,.Civil Code.)
Slde Setback from Property Llne,
Lender's Name
- Lender's AddressFINAL
DATE
INSPECTOR
This' is -a building permit when properly filled out, signed and validated, and is subject to
expiration it work thereunder is suspended for 180 days. ,-•
I certify that I have read this application and state that the above information in correct.
Issued by:
`" Date Permit
I agree to comply with' all city and county ordinances and state laws relating to building -'
construction, and hereby authorize representatives of this city to enter the above-.--
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mentioned property for inspection purposes.
Validated by:
Signature of applicant � '. ' � ..2$ - i . ��gr Date _ 1 :
Mailing Address,�' 'fit"`W
Validation:
City, State, Zip
A60i0
) 29 •2256 U
HARD COPY
a
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 SQ. 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.000L HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APP./EQUIP.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
TEMP. POLE
KITCHEN SINK
ABSORPTION SYSTEM. B.T.U.
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. ® c
BATH TUB
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
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SO.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./EQUIP.
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
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REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL