06515 (SATT)"4 4 315 -5-
P.O. BOX 1504 N o , 06515
Building 54-463 Riviera LA QUINOTAC
Address CALIFORNIA 92253
Owner .
stmri" empanyr
Mailing BUILDING: TYPE CONST. OCC: GRP.
Address 42-600 loom� St.IP #200 A.P. Number PCA West - Tract 24317-1
City Zip Tel.
Palm Desert 92260 Legal Description
ContractorF! li
Project Description Pj'4aR3sd Plan 30M
Address
City T Zip Tel_'
State Lic. City
& Classif. 283130 Lic. # 32$ Sq., Ft. 2826 No. No. Dw.
Arch., Engr., Size Stories Units
Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address Tel.
City Zip State
Lic. #
LICENSED CONTRACTORS 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 Cade, and my license is in full force and
effect.
SIGNATURE DATE
OWNER -BUILDER DECLARATION Estimated Valuation to
I hereby affirm that I am exempt from the Contractors License Law for the following $Y9L�69�2
reason: (Sec" 7031.5.6usfiress and Professions Code: Any city or county which requires a
permit to construct, after, drove, demolish, or repair any structure, prior to its issuance also
requires the applicant for such pemdt 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
OavLvon 3 of the Business and Professions Code, or that. he is exempt therefrom, and the basis
for the a)leged exemption" Any violation of Section 7031"5 by "any applicant for a permit Plan Chk. Dep.
• subjects the appfucant 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. 8102.21
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and Const. 772 • VO
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. 82.50
provided that such improvements are not intended or offered for sale. If, however, the building
or improvement is said within one year of completion, the owner-buffder will have the burden Electrical Y 2• $�,
of 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 204•00
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. 13065
such projects with a contractorfs) licensed pursuant to the Contractor's License Law.)
Grading
❑ I am exempt under Sec B. & P.C. for this reason
Driveway Enc.
Date owner Infrastructure $4,380,57 2,190.24
Less Credit 2,190.34
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. f
TOTAL $4,407.06 ': " `r 7.71
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed it 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.
DateOwner
NOTICE TO APPLICANT: 8, after making this Certitkate of Exemption you should become
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such proviskms or this permit shag be deemed revoked.
CONSTRUCTION LENDING AGENCY
Ihereby 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
Lenders Address
This permit is a building peit when property filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days.
I certify that 1 have read this application and state that the above information is correct:
1 agiee 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,
Signatureof applicant Date
Mailing Address
City, State, Zip
REMARKS
Y tA>.M0 t TV AV i' I, `mus : Jia
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
10/13/39
Issued by: Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
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. SQ. FT.
�GAS (ROUGH �Qv
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.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
/�
eIJ�tFRAMING /
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
// / S`� ��
LAUNDRY TRAY
AIR HANDLING UNIT CFM
REMARKS:
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.
SQ. FT. ® c
BATH TUB
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.W.
SO. FT. RESID ® 1% c
SEWAGE DISPOSAL
SQ.FT.GAR ® V4c
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTA-L FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETACK
OUND PLUMBING�� �6
UNDERGROUND
A.C. UNIT
COLL. AREA
GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS r
^
EWER OR SIH Ai�Q , /
ROUGH WIRING
DUCT WORK
ROCK STORAGE
U . REINF.
�GAS (ROUGH �Qv
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
EINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
_$
LUMBER GR.
//
NAL INSP-7
/�
eIJ�tFRAMING /
FINAL INSP.
KROOFING - -�
11
// / S`� ��
/ 2 t/J�`
REMARKS:
VENTILATIONj�
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
WNSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL