003200 (SATT)Building
Address
Owner
TA•4.
hf
P.O. BOX 1504 No. 003200
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
Address 75-005 %S unt—ry `alb Drive
City Zip Tel.
Palm Desert
g2�6� 5.88
Contractor
State Lic. City
& Classif. MOM Lic. # _M7
Arch., Engr.,
Designer
Address Tel.
CityZip State
.. .., - Lic. #
LICENSED CONTRACTOR'S DECLARATION
>j I herdbtyaffirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000)iof Division 3 of the Business and Professions Code, and my license is in full force and
effect: /t
SIGNATURE DATE
OWNER -BUILDER DECLARATION
1 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, -'after, 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
the provisions or 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
subjects the applicant to a civil penalty of not more than five hundred dollars ($500).' ''
❑ 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
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,
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
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 or property who builds or improves thereon, and who contracts for
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) .
❑ 1 am exempt under Sec. -B..& P.C. for this reason
BUILDING: TYPE CONST. - OCC: GRP.
A. P. Number
Legal Description
Project. Description FMce 30--A. Plan 2SM.R
Builder I
Sq. Ft. -DWO 103 No. No. Dw.
Size r.AR 6226 Stories Units
New ❑ Add ❑ Alter ❑' Repair ❑ Demolition ❑
Estimated Valuation
$1.15,727.00
PERMIT AMOUNT
Plan Chk. Dep.
Plan Chk. Bal. 6 me►n. AA
Const.
'Mech.`_
Electrical All 17'
Plumbing ov"Ott%
S. M. 1. �+
Grading
Driveway Enc.
Date owner Infrastructure
WORKERS' COMPENSATION DECLARATION
I 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 No. .Company
O Copy is filed with the city. ❑ Certified copy is hereby furnished. '
_ TOTAL
CERTIFICATE OF EXEMPTION FROM REMARKS
WORKERS'. COMPENSATION INSURANCE
r, �- [[ff
(This section need not be completed if the permit is for one hundred dollars ($100) valuation �tF^eti {,�:�. CS5R!31__0.,6-29-J3,7__ "", ,., ,_4_2
or less.) .. j t3 °t+hl.�e t7 Ta.
I certify that in the performance of thg work for which this permit is issued, 1 shall not i U I NL s
'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
subject to the Workers' Compensation 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 certify that I have read this application and state that the above information is correct.
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.
Signature of applicant Date
Mailing Address '
City, State, Zip
HARD COPY
ZONE:
BY:
Minimum Setback Distances:
Front Setback from. Center Line
Rear Setback from. Rear.Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL, DATE
INSPECTOR
Issued by:
Date g tftx ta's Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST 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
COLL. AREA
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
FORMS
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
ROUGH WIRING
LAUNDRY TRAY
AIR HANDLING UNIT CFM
DUCT WORK
KITCHEN SINK
ABSORPTION SYSTEM. B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET
COMPRESSOR HP
POLE, TEM/PERM
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.
SO. FT. RESID @ 1% c
SEWAGE DISPOSAL
SQ.FT.GAR @ 3/ac
HOUSE SEWER
FINAL INSP.
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
J
MECH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE ---I PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
GROUND PLUM I G
UNDERGROUND�1
! NIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
y
SEWER OR SE ICT N
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF. if 467 7
GAS (ROUGH)
%j
r�
///-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 x$
=$
LUMBER GR.
FINAL INSP. (A Af 7
FRAMING C7 �
. FINAL INSP.
r /�7
ROOFING q/i
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING l�
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL