06162 (SFD)Tiht 4 4 Q"
P.O. BOX 1504
Building 78-105 CALLE ESTADO
Address 55-483 Ca Hill LA QUINTA, CALIFORNIA 92253
Owner
Mailing
Address 42-600 OD61k. St., SuAte 200 „
City Zip Tel.
Palm Desert 192260
Contractor
National Mortgage 6 band
Address
Same
City lZio I Tela
State Lic.I City
& Classif. 288130 Lic. # 398
Designer
Address Tel.
CityI Zip I State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
1 herebyaffirm that I am licensed under provisions of Chapter 9 (commencing with Section
effect
70pgjof Division 3 bf the Busin_ ess,and Professions Code, and my license is in full -force and
V.
SIGNATURE DATI
OWNER -BUILDER DECLARATION /
I hereby affirm that I am exempt from the Contractor's License law for the following
reason: (Sec. 7031.5,Susiness and Professions Lode: 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 We a signed statement that he is licensed pursuant to
the provisions of 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
lla
of not more than five hundred dors (5500).
❑ 1, as owner of the property, 0r 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. 1/, however, the building
or improvement is sold within one year of completion, the owner-bufider will have the burden
of proving that he did not build or inprove for the purpose of sale.)
0 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 bw7ds or improves thereon, and who contracts for
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
❑ l am exempt under Sec. B. & P.C. for this reason
Date owner
WORKERS' COMPENSATION DECLARATION
1 hereby affirm that '1 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.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed ff 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: d, after makimg 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
1 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 property 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
No.
UILDING:- TYPE CONST. OCC: GRP.
.P. Number PGA 'feat
egal Description
roject Description Tract 20717_1 -
P3,m R3BR
Sq. Ft.
Size
New ❑
2899 stories
®61.62
No. Dw.
Units
Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation $214,923
PERMIT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
Less Credit
TOTAL
REMARKS
AMOUNT
Y ��Yf f.SV
1,042.00
73.€ 0
132.71
168.50
15.05
.77 2,41.7.89
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
8/x.1/39
Issued by:
Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. ® $
UNITS
14AB GRADE
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL. SO. FT. ®
FORMS
ER OR SE T
ROUGH WIRING.
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
OUGH) / 1
V
METER LOOP
HEATING (FINAL)
POWER OUTLET
ROOF DRAINS
GAR. SO. FT. ®
TEMP. POLE
GROUT
DRAINAGE PIPING
CAR P. SO. FT. ®
FINAL INSP.
BOND BEAM
WATER SYSTEM
DRINKING FOUNTAIN.
WALL SO. FT.
LUMBER GR.
FINAL INSP.
AMING �b
URINAL
SO FT ®
Y
ESTIMATED CONSTRUCTION VALUATION $
REMARKS
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
I
IWATERSOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
SPARK ARRESTOR
LAUNDRY TRAY
AIR HANDLING UNIT CFM
I
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.
SO. FT. ® c
BATH TUB
FINI GRADING
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SO.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
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
UND PLUMBING P
UNDERGROUND
A.C. UNIT
COLL. AREA
14AB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
ER OR SE T
ROUGH WIRING.
DUCT WORK
ROCK STORAGE
OUND. REINF. T (6
/
OUGH) / 1
V
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
J&S
INAL) ' 2
TEMP. POLE
GROUT
WATER HEATERVICE''tZ
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ -Plus-X$-=$
LUMBER GR.
FINAL INSP.
AMING �b
FINAL INSP.
OOFING
Y
REMARKS
VENTILATION
FIRE ZONE ROOFING:
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
l6ld
SULATION/SOUNDIV
FINI GRADING
-AL INSPECTION l�
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL