06335 (SATT)4
P.O. BOX 1504 N o .
Building547$1 1V�rir8 7&105 CALLE ESTADO
Address LA.QUINTA, CALIFORNIA 92253
Owner
s, -;r;„- BUILDING: • TYPE CONST. OCC: GRP.:
Address 75-005 utry Club Dr.
City Zip Tel.
Palm Desert 92260 568»-2828
Contractor
Address
State Lic. I City
& Classif. 288130- Lic. # 328
Arch., Engr.'
Designer
Address I Tel.
City IZip I State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby* affirm that 1 am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of the Business and Professions Code, and my license
Y` is in full force and
effect. ,
SIGNATURE ' - . - DATE
r IOWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractors License Law for the following
reason: (Sec. 7031.5,Buskmss and Professions Code: 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 chd penalty of not more than five hundred dolfars ($500).
❑ 1, 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, Suisness 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 safe. If, however, the building
or Improvement is sold with one year or completion. the owner -budder wig have the burden
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-
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
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
O 1 am exempt under Sec_ a. & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
I 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 fumished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100) valuation
or less.)
1 certify that in the performance of the work for which this permit is issued, 1 shall not
employ anyperson in any manner so as to become subject to the Workers' Compensation
Laws of California.
Date Owner
NOTICE TO APPLICANT: If, after making this Certilkate of Exemption you should become
subject to the Workers' Cortpensation provisions of the tabor Code, you must forthwith
comply 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.)
Lender's Name
Lenders Address
This is abuilding 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 bbmply 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
z -z-
05335
P. Number MA Went — 'and 30H
Legal Description
Project Description ' Tract 2.' 317--1. Plan 2(N
Sq. Ft. 2596No.
Size
No. Dw.
Stories Units
New ❑ Add ❑
Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
$179,°1S
PERMIT
AMOUNT
Plan Chk. Dept
Plan Chk. Bal.
17
$
Const
319. (i
Mech.
82.50
Electrical
1.34_.36
Plumbing
198.00
S.M.I.
12.60
Grading
Driveway Enc.
Infrastructure
$4,045.90 2,022.95
Less Credit
2,022.35
TOTAL
S,49131-08 %, 'y
REMARKS
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_I�SPEJT�OR
Issued by: Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SQ. FT. ® $
UNITS
COLL. AREA
2ND FL. SQ. FT.
ROUGH PLUMB.
YARD SPKLR'SYSTEM
BONDING
MOBILEHOME SVC.
BAR SINK
POR.. SQ. FT. ®
SEWER OR SEPTIC TANK
GAR. SQ, FT. ®
POWER OUTLET
ROOF DRAINS
FOUND. REINF. /
GAS (ROUGH)
DRAINAGE PIPING
CAR P. I SQ. FT.
HEATING (FINAL)
OTHER APPJEQUIP.
WALL SQ. FT.
GAS (FINAL)
DRINKING FOUNTAIN.
SQ FT @
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER HEATER
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
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
FINAL INSP.
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.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® V4c
HOUSE SEWER
LATHING
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOT^L FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
OUND PLUMBING !U
UNDERGROUND
A.C. UNIT
COLL. AREA
GRADE L
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 APPJEQUIP.
NY. STEE
GAS (FINAL)
TEMP. POLE
OUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plug 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 SIGNATURES/INITIALS
GARDEN WALL FINAL