003343 (BLCK)Buildin
Address 55-355 Oak Hill
Owner
Mailing
Address 75-005 Country Club Drive
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number.. =A, Maze
No. 003343
City Zip Tel.
Palm . Desert 92260 - 564-�0716
Contractor
hatiop.0 Land Mortgage
..Address .
City Zip Tela
Legal Description
Project Description Tratt 20717-1s Phase 5C
81-ock wi3 i 75 "lin. ft. XV
State Lic.
City
& Classif.
�3
Lic. # 3
Sq. Ft.
No. No. Dw.
•Size
Stories Units
Arch.; Engr., _.
' Designer
New ❑ 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 license is in full force and
rs
effect.
SIGNATURE r;- r F:..r ::: .?/ "'6 -" 9 —C dDATE
.. -.
.
` JOWNER•BUILDER DECLARATION
Estimated Valuation
I hereby affirm that I am exempt from the Contractor's License Law for the following
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$t�T
reason: (Sec. 7031.5,Business and Professions Coder Any, city or county which requires a
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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 provsions of the Contractor's License Law, Chapter 9. (commencing with Section :7000) of,
=-1^
-
'Division 3:16f the Business and Professions Code, or that, he. is exempt therefrom, and: the .basis-
Any Section by 'any for
Plan.Chk. 'be P.
for the alleged exemption. violation of .7031.5 applicant •a .permit
subjects the applicant to'a civil penalty of not more than five hundred dollars ($500).
Flan. Chk. Bal.
01, 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
Const.}+
Professions Code: The Contractor's License Law does not•apply to an owner of.property who
d s .�'.
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
.
or 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
Strutt 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
S.M.I.
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
Grading
,
❑.1.am. exempt under Sec. B. & P.C. for this reason
Driveway Enc.
Date Owner
Infrastructure
WORKERS' COMPENSATION DECLARATION
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
El Copy is filed with the city., . ❑ 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 ($100) valuation -
or lel certify that in the performance of th work for which this ermitis issued, I shall not
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'rti'� .ti 4•` «•`>�,"r'"'ki}-�' ^•4 }-
-
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
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
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.)
Side Setback from Property Line
Lender's Name
Lender's Address
FINAL DATE
INSPECTOR
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: -
Issued by:
DateA/31 /A7 Permit
I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives sof 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
1ST FL. SQ. FT. ® $
UNITS
SLAB GRADE
2ND FL. SQ. FT.
BONDING
YARD SPKLR SYSTEM
POR. SQ. FT. ®
MOBILEHOMESVC.
BAR SINK
GAR. SQ, FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SQ. FT.
GAS (ROUGH)
DRAINAGE PIPING
WALL SQ. FT. ®
OTHER APPJEQUIP.
DRINKING FOUNTAIN
SO. 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.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FINAL INSP.
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, TEM/PERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SO. FT. ® c
BATH TUB
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/a c
SEWAGE DISPOSAL
GAR. FIREWALL
SQ.FT.GAR ® 3/ac
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
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REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INzorcti l VM"J Jiu FFA 1 umrw IYI I IALb.
GARDEN WALL FINAL