003387 (ELEC)Building
Address
Owner
Mailing
Address
7q -An; Catintru Clamh %3r
City Zip Tel.
Palm Desert 3226(3 . 564
Contractor
National Land & Mortgage
Address
lZip
State Lic.
& Classif.. 288 130
Arch,; Engr.,
Designer
Address
P.O. BOX 1504 No,
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
BUILDING: TYPE CONST. OCC: GRP..•
A.P.-Number OAA Qa mSt
-5716 Legal Description
Project Description N"ad0l it fnnl �x Chi wnl olr4"t
-Prod ct Line 100 AMf, Yard 'Lighting
Irrigation
Lic
'#328
Tel.
Sq. Ft.
Size
New ❑ Add ❑ Alter ❑ Repair ❑
No. No. Dw.
Stories Units
CityZip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter9 (commencing with Section
7000) of Division 3,of the Business and Professions Code; and my license is in full force and
effect. . i . _ t . .. - f,> -.y
} A i =3 j Ei.., r
SIGNATURE r 11 .r^' DATE
.r . OWNER -BUILDER DECLARATION '
I hereby affirm that I am exempt from the Contractor's License Law for the following E'
n ..
reason: (Sec. 7031, S,Busin ass and Pro/essions Code: Any. city or county wh,ch'regwres a
permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance also
.requires the applicant for such permit to rile a signed statement that he is licensed pursuant to '
the provisions or the Contractor's License .Law, Chapter 9 (commencing with Sectionc7000) of
- PERMIT .
'
' Division 3* of the Business and Professions Code, of that: he is' -exempt therefrom, and`the basis.'
for the ,alleged exemption. Any violation of Section 7031.5 by 'any applicant for- a permit
• '
Plan Chk: Dep.. -..
' subjects the applicant to a civil penalty of not more than rive hundred dollars ($500).
' 0 I, as owner of the property, or my employees with wages as their sole compensation, will
Plan .Chk: Bal.
Const..
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
Mech.
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
., or improvement is sold within one year or completion, the owner -builder will have the burden
of, proving that he did not build or improve /or the purpose or sale.) ,
-Plumbing
❑ 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 builds or improves thereon, and who contracts for
S.W. -
such projects with a contractors) licensed pursuant to the Contractor's License Law.)
O 1 am exempt under Sec. B. & P.C. for this reason
Grading
Driveway Enc.
Date owner
Infrastructure
NOTICE TO APPLICANT: If, after making this Certificate of Exemption 'you should become
WORKERS' COMPENSATION DECLARATION
BY:
"I hereby affirm that I have a certificate of consent to'self-insure, or'a certificate of
Minimum Setback
Worker's Compensation Insurance, or a certified copy thereof. (Sec: 3800, Labor Code.) .
comply with such provisions or this permit shall be deemed revoked.
Policy No. Company
❑ Copy is tiled with the city. ❑ Certified copy is hereby furnished.
Front Setback from Center Line
TOTAL
Demolition ❑
AMOUNT
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 less. ' ' -
I certify that in the performance of ing work for which this permit is issued, I shall not
•.
employ -any person in 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,-Civi-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 it work thereunder is suspended for 180 days:
I
0
certify that I have read this application and state that the, above information is correct.
Issued by:
Date tPem-lit
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
t ° HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
2ND FL. SO. FT. ®
POR. SO. FT. ®
GAR. SO. FT. ®
CAR P. Q. FT.
WALL SO. FT. ®
SO. 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.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APP./EOUIP.
LAUNDRYTRAY
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
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11A c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/4c
HOUSE SEWER
REMARKS:
GAS PIPING
PERMIT FEE
PERMIT FEE
I 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./EOUIP.
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
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
Cl. I V A J JI V 19M I V nCJ1119111NLJ,
GARDEN WALL FINAL