002505 (ELEC)Building 80-3555 Petiole B
Address
Owner
su=ise
Mailing
Address 75-005 Country Clxb tk]lm
P.O. BOX 1504 NO. 00205 . O b
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
CityJZip Tel. "
092260. . ,,.568728323
Contractor
Address...
Sam
Zip - . Tela
State Lic. City
& Classif:.. 288130 Lic. #
Arch Engr
'328,
BUILDING: TYPECONST. OCC: GRP.•
A.P. Number
Legal Description
Project Description' "' '�SE awl
Sq. Ft. No. No. Dw.
Size • - Stories Units
-Designer _ New Ck Add ❑ Alter ❑•' ...Repair ❑
Address Tel.
City Zip State100+ mol Pedestal
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with'Section
70 00) of Division 3.pof the Business and Professions Code, and my license is in full'force and
effect... of
Driveway Enc.
DATE
Infrastructure
' 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-auch permit to file a signed statement that he is *licensed pursuant .'to
EStlnlated,ValUatlOn
.
'
-
..PERMIT ->'-•
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
- d
Plan Chk: Dep.-
-subjects the applicant to a'civil penalty of not more than five hundred dollars ($500). -. > • • 5. •
' 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 ander
Prolessirns Code: The Contractor's License Law does not apply to an.owner of property, who
- -
Plan Chk. Bal..
Const..•
'Meeh.
bui'Ids or improves.thereon and who does such workhimself or through his own employees,
provided that' such improvements are not intended or offered for sale. If, however, the ,building -
� Electridal - '
or improvement is sold within one year of completion, the owner -builder will have the burden
of proving tharhe did not build or improve for the purpose of sale.)-
-Plumbing
❑ I, 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"
•. S.M.I.
does not apply Jo an owner of property who builds or improves thereon, and who contracts for
-such projects -with a contractor(s) licensed pursuant do the Contractor's- License Law.)
O 1 am exempt under Sec. �- B. & P.C. for this reason
..
Grading
Demolition ❑ ,
Driveway Enc.
Date Owner
Infrastructure
WORKERS' COMPENSATION DECLARATION
I hereby affirm' that I have a certificate of consent to self -insure, or 4 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
22.50
• CERTIFICATE OF EXEMPTION FROM
REMARKS
WORKERS' COMPENSATION INSURANCE ...
(This section need not be completed if the permit is for one hundred dollars fS100) valuation
- -
:,Orless.). .. _
I certify that in the performance of thg 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: Il, 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. --
.• .Minimum Setback Distances: -
Front Setback from Center.Line
Rear Setback from Rear Prop.. Line
CONSTRUCTION LENDING AGENCY
Side Street Setback from,Centef Line
1 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 Property Line -
Lender's Name
Lender's Address
FINAL DATE
IIVSPECT.OR:'
This is a building permit when properly filled out, signed and validated, and'is subject to
:
_
expiration if work thereunder is suspended for 180 days.• '. ..-.
J certify that l have this
�. .. .'
7-29 -(Permit
read application and state that the above information is correct.
-Issued by:
Date
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. - - qK, - • {
Signature J !� E.J r: r J 7 n!
Validated by:
of applicant .� . - Date -1
Mailing Address �'fv (
Validation:
City, State, Zip
A6068'
7 29 22,56 9
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
2ND FL. SO. FT.
POR. SO. FT. ®
GAR. SO. FT. @
CAR P. SO. FT.
WALL SO. FT. ®
SO. 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, TEMIPERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SO. FT. ® c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ac
HOUSE SEWER
REMARKS:
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
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'5 51ONAl URE511NITIALS
GARDEN WALL FINAL