06538 (SFD)4
P.O. BOX 1504
Building 78-105 CALLE ESTADO
Address 54-730 Riviera LA QUINTA, CALIFORNIA 92253
Mailin
Address 42-600 Cook St., #240
City Zip
Palm Desert 32260
Contractor
Natimal ftrggaZea
Address
Sage
No. 065383
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number PC® West _ Tract 24317-I
568-2828 Legal Description
Project Description Vhase Pian 03A
State Lic. 288 13I City 328
& Classif. Lic. # -
Arch., Engr.,
Designer
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
effect
SIGNATURE DATE
OWNER -BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractor's License Law for the following
reason. (Sec. 7031.5,Business and Professions Code: Any city or county which requires a
pem* to construct, ager, 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
the provisions of the Contractor's.License Law, Chapter 9 (commencing with Section 7000) of
Divisim 3 of the Business and Professions Code, or that. he is exempt therefrom, and the basis
for flue alleged exemption. Any violation of Section 7031.5 by *any applicant for a permit
subjects the applicant to a civil penally of not more than two hundred dollars ($500).
❑ I, as owner of the property, or my employees with wages as their sole compensation, will
do the word_ 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 rrproves thereon and who does such work himself or through his own employees,
provided that suchrrprovements are not intended or offered for safe. If, however, the building
or improvement is sold within one year of completion, the owner -builder will have the burden
of proving that he did not build or improve for the purpose of safe.)
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-
struct the project (Sec. 7044, Business and Professions Code: The Contractors License Law
does not appy to an owner of property who builds or improves thereon, and who contracts for
such projects with a contractor(s) 5censed pursuant to the Contractor's License Law.)
❑ I am exempt under Sec B. & P.C. for this reason
Date twiner
WORKERS' COMPENSATION DECLARATION
hereby affirm that I have a certificate of consent to self -insure, or a certificate of
Workers Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Polity 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 if the permit is for one hundred dollars (S100) valuation
or less.)
certify that in the performance of thg work for which this permit is issued, I shall not
employ any per,on in any manner so as to become subject to the Workers' Compensation
Laws of Cali omia
Date owner
NOTICE TO APPLICANT: 11, after making this Certifuate of Exemption you should become
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
oompy with such provisions or this permit shall 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.)
Lenders Name
Lenders Address
This isa 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.
1 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
Sq. Ft. 3031NO.A No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
PERMIT AMOUNT
Plan Chk. Dep.
Plan Chk. Bal. I s
Const. ! . "+!
Mech. ts I .
Electrical A40Al
Plumbing Myq 1)
S.M.I.
Grading
Driveway Enc.
E, Infrastructure � 'aF -
as U11111112az j
TOTAL.=
REMARKS
.t. —" '.:l^tr:, rites x"Y:3v afK:.- ♦ ,, �., o.v
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 INMi60�Fi
Issued by: Date __Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES '
1ST FL. SQ. FT. ® $
UNITS
COLL. AREA
B GRADE J
ROUGH PLUMB.
YARD SPKLR SYSTEM
2ND FL. SQ. FT.
HEATING (ROUGH)
STORAGE TANK
FORMS
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
DUCT WORK
ROCK STORAGE
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
HEATING (FINAL)
DRAINAGE PIPING
CAR P. SQ. FT.
GAS (FINAL)
TEMP. POLE
WALL SQ. FT.
DRINKING FOUNTAIN.
SQ FT ®
WATER HEATER
URINAL
ESTIMATED CONSTRUCTION VALUATION $
FINAL INSP.
WATER PIPING
NOTE: Not to be used as property tax valuation
WATER SYSTEM
FLOOR DRAIN
MECHANICAL FEES
GRADING
cu. yd.
$ —Plus—X$—=$
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
OOFING / Oate.
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
A! '
�(�
LAUNDRYTRAY
AIR HANDLING UNIT CFM
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
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.J.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ac
HOUSE SEWER
MESH
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
S BACK
NO PLUMBING,
UNDERGROUND
A.C. UNIT
COLL. AREA
B GRADE J
ROUGH PLUMB.
/ BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR Sri tAMN
ROUGH WIRING
DUCT WORK
ROCK STORAGE
ND. REINF. a
AS (ROUGH' r —/G
•)
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.
FINAL INSP.
FRAMING 3 �.v
FINAL INSP.
OOFING / Oate.
( O
wK x�/o � � V
A! '
�(�
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
ZMLATHING
MESH
qu&NSULATIONISOUNE�.S—/
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL