002179 (BLCK)Building 54_290 Cok T
Address
Owner
Mailing
Address 05 Ommtry Club D
City Zip
Palm Desert Zip
Contractor
4
P.O. BOX 1504 No, 002179
78-105 CALLE ESTADO
LA QU.INTA, CALIFORNIA 92253
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number
Tel.
Legal Description
PM .Project Description tam i A
-MLcm. malls t:=alt • P.i3. e
.. ..Tel:
State Lic.
City
Minimum Setback Distances:
& Classif..
Lic. #
Sq. Ft.
No. No. Dw.
Side Street Setback from Center/Line
Size - 32: UM...
dtStories -Units.
Arch.; Engr .
INSPECTOR'
Issued by:
Designer
New E�t Add ❑
Alter ❑ Repair ❑ Demolition ❑
Address
Tel.
A4824
3 18 t2S52 CK
City
Zip
State
...
Lic. # -
LICENSED CONTRACTOR'S DECLARATION
hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000)`of Divisionof the Business and Professions Code, and my license is in full force and
13
effect..
SIGNATURE\ DATE
'4 OWNER -BUILDER DECLARATION
1,lieretiy.affirm I that am exempt.from the Contractor's License Law for the following
Estimated Valuation
' T•fE
7'�e
d. I d
reason: (Sec. 7031.5, Business and Professions. Code: Any city or county, which. requires a
permit to construct, atter, 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 provisions of the Contractor's, License Law, Chapter 9- (commencing with Section 7000) of
-Division 3 of the Business and Professions Code, or thathe is exempt therefrom, and the basis
for Any Section 7031.5. by: 'any for
Plan'Chk, Dep... -
the alleged exemption. violation of applicant a. permit
subjects the applicant to a civil Penalty of not more than five'hundred dollars ($500).' '
Plan Chk. Bal.
[A
G7.�6
❑ 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
Const.
s� �-A
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,
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
of proving. that he did not build,or improve for the purpose of sale.) -
❑ 1, as owner of the property, am exclusively contracting with licensed contractors to con-
Plumbing
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.M:I.
- ♦�3�
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
Grading
O 1 am exempt under Sec. B. & P.C. for this reason
Driveway Enc.
Date Owner
Infrastructure
WORKERS' COMPENSATION DECLARATION
I hereby'affimi.that I have 'a certificate of consent to selfinsure, or.a'certificate of
Worker's Compensation Insurance, ora certified copy.thereof..(Sec. 3800, Labor Code.)
'
Policy No. Company
0 -Copy is filed withthe 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 less.)
certify that in the performance of the 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. 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 f Date '+ M •'
Mailing Address -
City, State, Zip
T
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 3-13-36Permit
Validated by:
Validation:
A4824
3 18 t2S52 CK
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
SLAB GRADE
2ND FL. SO. FT.
BONDING
YARD SPKLR SYSTEM
POR. SQ. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. I SQ. FT.
GAS (ROUGH)
DRAINAGE PIPING
WALL SQ. FT.
OTHER APP.IEQUIP.
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.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FINAL INSP.
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
KITCHEN SINK
ABSORPTION SYSTEM. B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET7'
COMPRESSOR HP
POLE,TEMIPERM
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 ® 11/4 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 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.
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
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL