12508 (ELEC)Tity 4 SCP "
Ll l= y y j. i 1 P.O. BOX 1504 No.
Building r 78-105 CALLE ESTADO
Address-ilsTl3dtr� 1, l : LA QUINTA, CALIFORNIA 92253
w 'r}
Mailing
BUILDING: TYPE CONST. OCC. GRP
Address }''27"_3 A.P. Number
City Zip Tel.
.iciT �3L'�'1.; �?'C i .':ram fir'. 9 4 � i! ; g i? —' Y f k Legal Description
Contractor
Address
City W 92406
p
3A nar--3 i n4
State Lic. C1ty
& Classif. Lic. #
Arch., Engr.,
Designer
Address Tel.
City I Zip I State
+ I
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I horoby affirm that I am licensed under provisions of Chaptei 9 (uuuunencing with Section
70M of DIvislon 3 of thejBusiness and Professions Code, and my license is in full force and
-Affect.
ySIGtJ! 4�gE_ DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,tiusiness and Professions Cade: Any city or county which requires a
permit to construct, allot, improve, demolish, or repair any structure, prlor to its issuance also
rogdires the applicanr for such permit to lite a signed staternent that he: is licensee puisuartt to
the previsions of the Conhactors License Law, Chapter 9 (commancing with Sectlan 7000) of
Division 3 of the Business and Professions Code, or fhat he.is exdmpr moratlam, and the basis
for the alleged exemption. Any violation of Section 7031.5 ❑y arty applicant f0v a pemril
subjects the applicant to a civto7panally of nor more than flva hundrad dollars fS500).
El I, as owner of the property, or my empipyees with wages a their sole comp ens atlon, will
do the work, and the structure is trot Intended or offered for sale. (Sec. 7044. Bussness and
Professions Code: The Contractor's License Law does not apply la an owner of property who
builds or improves tharean and who does such work himself or through his own empfdyees,
provided That such improvements are not intended or offered for sale. tf, howovar, the pilfldIng
ar improvemont is sold within one year of completion, the owner-butTder wf# havb rho .burden
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-
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
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
❑ I am exempt under Sec. B. & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
1 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 Nocornpany
❑�y is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
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 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: U, after making this Cerlifieafe of Exemption you should become
subject to the Workers' Cnmpenrailorr provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I 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.)
Lender's Name —
Lender's Address
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.
I Celli ly that 1 have read this application and state that the above information is correct.
I agree fa. Comply with alt city and County ordinances and state laws relating to building
Construction, and hereby authorize representatives of this city to enter the above-
menttoned properly for Inspection purposes.
Signature of applicant Date
Mailing Address
City, State, zip
12508
Project Description
Sq. Ft. No. No. Dw.
Size Stories Units
New ❑ Add ❑
Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
I
REMARKS
.' ! I
j
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line L ;
Rear Setback from Rear Prop. Li
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DA
INSPECTOR
Issued by; Date Permit
Validated fay;
Validation:
CONSTRUCTION ESTIMATE
NO.
ELECTRICAL FEES
NO.
PLUMBING FEES
1ST FL SO. FT. g
2ND FL. SQ. FT. a
POR. SQ. FT, a
GAR, SO. FT, OF
CARP SQ. FT: CD
WALL SQ. FT, rp
SQ. FT. ft
ESTIMATED CONSTRUCTION VALUATION
$
I
UNITS
YARD SPKLR SYSTEM
MOBILEHOME SVC
BAR SINK
POWER OUTLET
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
Is
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
ISIGN
WASHER(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.
SQ. FT. ® c
BATH TUB
SQ cr .a.
WATFR HFATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.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
i
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.IEQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x5
=$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFI N 6
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING4 of
I
ffL�N AL INSPECTION
CERT. OCC.
FENCE FINAL
ST75 PE C TO R' 5 SIG NAT U RESiIN IT IA LS
GARDEN WALL FINAL