003372 (BLCK)Address 54-889 Oak Hill
Owner
National Nortnane
Mailing
Address
City Zip
- Palm Desert ... 92260
Contractor ,
ress
C&hf 4
P.O. BOX 1504 No. 003372
78-105 CALLE.ESTADO
LA QUINTA, CALIFORNIA 92253
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number PGA West
5W- Legal Description
Project Description —Phase.'30A o 32P -of Block Wal".
".
" City
Zip
Tela '
State Lic.
City
& Classif. 288130
Lic. # 328
Sq. Ft.
No. No. Dw.
Size
Stories Units
Arch:, Engr.; .. .
Designer
New ❑ Add ❑
Alter Cl -❑. Demolition ❑
Address
Address
Tel.
-
City
Zip
State
_
Lic: #
LICENSED CONTRACTOR'S DECLARATION .
I hereby affirm that L: m licensed under provisions of,Chapter 9 (commencing with Section ='
• 7000) of Divisiont'3 of.the Business and Professions Code, and my license is in full force and
effect
.
SIGNATURE.-- -. „_ :;.., DATE
.. ..
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following's�¢�
Estimated VBIUatIOn
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 such 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 thathe' is exempt therefrom, and the .basis..
Any 7031•.5 for
Plan Chk. Dep.
- ..
for the alleged exemption. violation of Section by any applicant. a permit
subjects the applicant to a civil penalty of not more than,five hundred dollars ($500).
Bal.
Plan'tAA
..
'
A9
O I, as owner of the property, or m_ y 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
COflst.
A r%n
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,.
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
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
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.
'- M '
•s)
such projects with a contractorlicensed pursuant to the Contractor's License Law.) - -
Grading
-
O I am exempt under Sec. B. 8 P:C: for this reason
Driveway Enc.
Date owner
Infrastructure
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of'consent'to self -insure; of a certificate of .
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. Company
❑ Copy is filed with the city. O 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 IS 100)' valuation
-
or less.) - - -
I certify that in the performance of thg work for which this permit is issued, I shall not
-
�::*�ti t- l�+�> hx.Et:'—,t e1 �• R -. 1 =�
employ any person in any manner -so as to become subject to the Workers' Compensation
II .. i W r r -.a.. +, s C., .7 + r +-
Laws of California. -
Date" Owner
NOTICE TO APPLICANT: If, after making this Certificate or Exemption you should become
'ZONE:
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
'
Front Setback.from Center Line
Rear Setback -from Rear Prop. Line
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 *Property Line
Lender's Name
Lender's Address
FINAL DATE
INSPECTOR
This is a buildingpermit when properly filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days.
I certify that I have read this application and state that the above information incorrect.
Issued by:..
DatePermit '
' 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.
Validated by:
Signature of applicant Date
Mailing Address
Validation:
City, State, Zip
HARD COPY
CONSTRUCTION ESTIMATE
NO.. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SQ. FT. ® $
2ND FL. SQ. FT.
FOR. 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.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.
SQ. FT. ® c
BATH TUB
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/a c
SEWAGE DISPOSAL
SQ.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./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
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
1 UN"J WUNA 1 UKtWINI 1 IALS,
GARDEN WALL FINAL