15860 (ELEC)T v*'4 - Q
No•
11�� r
3 P.O. BOX• 1504 .' f 8� 6'� . :...
Building 78-495 CALLE TAMPICO
Address . 77-750 Ave Sty LA QUINTA, CALIFORNIA 92253
Owner f
La.
alinta C.C..
Mailing'. BUILDING: TYPE,CONST. OCC,. GRP.
Address .p.,O. .BOX 99
A.P. Number -
Clty Zip
3,a; _#j3detda 92253 564--4151 Legal Description '
t`
Contractor. Project Descnption Tiampora� ky Tentai~id `t
Address, ElectridaA f"r - vary. • StxQage
}; 57.00... indi6n Spring's Rai..
City Zip Tel.: '
Pai. Sj �lnr s 92?54 327-1111
State Lic ; City
kaassif , Lic. # Sq. Ft. t, , rA No. No Dw a`
y
Size t,'; Stories Units d
Arch. iEngr., r
Designer. New ❑ Add ❑•' Alter ❑ Repair ❑ Demolitionp..
Address Tel.
a ,t
City L Zip State
LICENSED CONTRACTOR'S DECLARATION
l.heraby 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
SIGNATURE DATE
OWNER -BUILDER DECLARATION
Estimated Valuation
I hereby affirm that I am exempt from the Contractors License Law for the following. $100. y
re on •703.1.5,13usfness and Pro/essfons Code: Any cfty or' county which requires a
permit to construct, after, fmprove, demollslm, or repair any structure, poor- to its issuance also l '
requlies;tne'applcant for such permit to me a signed statement that he is licensed pursuant to PERMIT" < AMOUNT_
Me;provfsionsb/ the Camtractor's License Law,, Chapter 9..(commencing wifA Section. 7000) of -
Dfvlsionthefness and Pro/esskms Code• or that. he is
exempt tnerelrom, and the basis r•
for
the alleged exemption: Any vblatbn of Section 7031.5 by
'any apAlicant 'or
a permit Plan Chk Dep.,-,
subieots me appkcanr to
a chi penalty m net more roan five
Hundred donars,($soo). Plan Chk Bal.1.0 0 .�
O I, as owner of'tha 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, Suisness and COr1St. -
Pio/essions.Code: The Contractor's License Law does not apply. to an owner of property who - E
builds or improves thereon and who does such *work himself or through his own employees, i,_
provided that'such improvements are not intended or offered for. sale. If, however,. the building Mech.. e
or:improvement is sold within one year of completion, the owner -builder will have the. burden Electrical
of proving that ne did not build or improve for the purpose of sale.) -
- 0' er of the. property, am exclusively contracting with licensed contractors to con- Plumbing
--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 for S.M.I. •tt:>:..
such proiects wiwa aontractorw pcensed pursuant to the Contractor's License Law.) -
Grading
❑.I aim exempt under Sec B. S P.C: for this reason
i. Driveway Encs..
t
.Date, owner Infrastructure
WORKERS' COMPENSATION DECLARATION
Thereby affirm that I have a certificate of consent to self -insure, or a certificate of
Worker's Compensation Insurance, or certified copy thereof: (Sec. 3800, Labor Code.)
Policy N Company -
opy Is filed with the city, ❑Certified copy Is hereby furnished.
TOTAL
10�..i�
CERTIFICATE OF EXEMPTION FROM : REMARKS "
WORKERS' COMPENSATION INSURANCE
(This: section need not be completed i/ the permit is for'one hundred dollars ($fo0) valuation - � x5spectacn fee 0r �$1 �- gpr
or less.) . - V_Tn . anq '-
I certify that in the performance of thq, work for which this permit is issued, �l shall not i
employ any person in any manner so as to become subject to the Workers' Compensation'
Laws of California '' r •'•
Date Owner . , y
NOTICE. TO APPLICANT: I/, after making, this Certificate of Exemption' you should become ZONE: - `r• BY:
' subject to the' Workers' Compensation provisions of- the -Labor. Code,- you must forthwith' .
Minimum Setback Distances: comply with such provisions or this permit shall be deemed revoked. h •
" Front Setba r Ce ter Line
Rear Se / om Re op_ Line
WARNING: FAILURE TO SECURE WORKERS' COMPENSATIONCOVERAGE IS.UNLAWFUL, AND Side _tr et Set ack r, enter Line
SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP. TO ONE.
HUNDRED THOUSAND DOLLARS ($100,000),.IN ADDITION TO THE COST OF COMPENSATION, Sid. ��back fr•Rrop y_Lin,:
DAMAGES+As PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND• ' ///���•'ti� i.
ATTORNEYS FEES
.This is a buildmg permit when'properly filled out, signed and validated, and is:subject to FINAL.DATE INS�,007
expiration if work thereunder is suspended for 180 days: e J� • ,' �z#fl
t certify that I have read this application and state that the above information is correct. Issued by pa Per 2' t
I agree to comply, with all city and county ordinances and state laws relating•to building ,t
constructron,',and'hereby authorize representatives .of, this city .to enter the' above Validated by.
mentioned property. for inspection purposes.. f �-
::
Signature of applicant Date
Malting Address Validation•
City,- Statep Zip
7777777 7
CONSTRUCTION ESTIMATE
NO.
ELECTRICAL FEES
No.
PLUMBINU FEES
1ST FL. SO. FT. ®
2ND FL. S0. FT. p
POR. SO. FT. ®
'GAR. SO. FT. ®
CARP. SO. FT. ®
' WALL SO. FT.
SO. FT. ®
ESTIMATED CONSTRUCTION VALUATION
$
UNITS
YARD SPKLR SYSTEM
MOBILEHOME SVC.
J
BAR SINK
'
POWER OUTLET
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN.h
URINAL
$
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
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 ® 1 Va c
SEWAGE' DISPOSAL
SO.FT.GAR ® 3/<c
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
STRUCTURE
PLUMBING ELECTRICAL
HEATING & AIR COND. SOLAR
SETBACK
GROUND PLUMBING
UNDERGROUND
A.C. UNIT.
COLL. AREA
BLAB GRADE
ROUGH PLUMB.
BONDING
HEATING -(ROUGH) '"
` STORAGE TANK..,-,-,
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCTWORK,
ROCK -STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP:
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. m.
FRAMING
FINAL INSP.
ROOFING
REMARKS: -
VENTILATION.
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
-MESH
- .. INSULATIONISOUND
FINISH GRADING
a
FINAL INSPECTIO /p - Y-�
v
CERT. OCC.
u ,
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL