003146 (SATT)0 14 4 . . . : I . 1 0
Abf��If�7N '
P.O. BOX 1504 N o . 003146
Building 78-105 CALLE ESTADO
Address 55-319 Oak HUI LA QUINTA, CALIFORNIA 92253
Owner
mailing
Address 75_005 Country Club
City Zip Tel
Palm. Desert . 1 92360 563-2828.
Contractor
National Nortgage' az Land
Address
BUILDING: TYPE CONST. OCC; GRP.
A.P. Number.
Legal Description
Project Description Phasb 5C Pias 100 CS
City
Zip
Tela
State Lia
& Classif.
City
Lic. #
Sq. Ft. DWG'3478
No. No. Dw.
Sized -696
Stories Units
' Arch:, Engr., .. .. _
Designer
New p Add ❑
Alter ❑ Repair ❑ Demolition ❑
Address
Tel.
City
Zip
State
Lic. #
. LICENSED CONTRACTOR'S DECLARATION. _-
I hereby 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 licenseis imfull force and}
effect. J
-
SIGNATURE DATE
OWNER -BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractor's License Law for the following
reason:. (Sec. 7031.5,Bus1ness 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
the provisions of the Contractor's License Law, Chapter 9. (commencing with Section .7000) o1
Estimated ValUatlOn
�i; w�g •��
8211.438.00
- PERMIT
AMOUNT
plan Chk. Dep.
�f f4 A
$250400
Division 3 of the Business and Professions'Codd, 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
Plan Chk. Bal.. .
,
-- �. ®g
Const..
.713-00,
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 applytoan owner.of property who
Meeh.
-8.
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.
Electrical
t E3�,
1
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.)
Plumbing
144.50
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-
struct the project. (Sec. 7044, Business and Professions Coder 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.
a .-
• 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
Grading
Driveway Enc.
Date Owner
Infrastructure
21000.00
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
❑ Copy is filed with the city. ❑ Certified copy is hereby furnished.
TOTAL
$3.665.01 $3a41%.02
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE -
This section need not be completed if the
( p 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.
REMARKS
-
°,�,,;3r F�'!-^:•- f r5-• t;.� , }
$�.tt � �[}t�� �•' j';, f' if" a ..i
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.
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY
Side Street Setback from Center Line
I hereby affirm that there is a construction lending agency for the performance of the
work for whi-;h this permit is issued. (Sec. 3097, Civil Code.)
Side Setback from Property Line
Lender's Name
Lender's Address
This is a building permit when properly tilled out, signed and validated,'and is subject to
FINAL DATE
INSPECTOR'
expiration it work thereunder is suspended for 180 days:
I certify.that I have read this application and state that the above information is correct.
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.
Issued by:
Validated by:
6/9/87
Dateprj/�/�% permit
Signature of applicant Date
Mailing Address
Validation.
City, State, Zip
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL SO. FT. @ $
UNITS
SLAB GRADE
2ND FL SQ. FT. @
BONDING
YARD SPKLR SYSTEM
POR. SQ. FT. @
MOBILEHOME SVC.
BAR SINK
GAR. SQ. FT. @
POWER OUTLET
ROOF DRAINS
CAR P. SQ. FT. @
GAS (ROUGH)
DRAINAGE PIPING
WALL SQ. FT. @
OTHER APPJEQUIP.
DRINKING FOUNTAIN
SQ FT @
TEMP. POLE
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GROUT
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SYSTEM
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
FINAL INSP.
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
IKITCHEN 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
GAR. FIREWALL
SQ.FT.GAR @ 3/ec
HOUSE SEWER
LATHING
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 APPJEQUIP.
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 -
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL