003850 (AR)P.O. BOX 1504 No. 003850
Building 78-105 CALLE ESTADO
Address 4Q- A 5 T. ere) 111701 LA QUINTA, CALIFORNIA 92253
Owner<.,.., ... _
Mr' Mrs" Willim SAI;afiah BUILDING: TYPE CONST. -= - OCC: GRP.
Mailing
Address : A.P. Number ic-AI—At111.. All A
City' Zip Tel. . - - ' e n_ _
>Q�'� Legal.Description
Contracto"r _ Project Description
Pill shadwich V
Address . • -
A,
City Zip ` Tel.
Palm Desert 92260 346-6995
State Lic. City
& Classif. 264394 Lic. # Sq. Ft. 307 No. No. Dw.
Arch., Engr., Size Stories Units
Designer New ❑ Add per, Alter ❑' Repair ❑ Demolition ❑
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 Estimated Valuation
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' fiiittsi
perms( to construct, after, 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 r,
Divisiou'3 of the Business and Professions Code, or -that -he is exempt therefrom, and the basis
for the alleged exemption. Any violation of Section 2031..5 by 'any. applicant for a permit Plan Chk..Dep. -
subjects the applicant 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. on 9111a
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and�r Y • ' "'�
Professions Code: The Contractor's License Law does not apply to an owner of property who CDnst. 1 ,�.� r. n
builds or improves thereon and who does such work himself or through his own employees, .Mach. a
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.) • �' n. ,f1
ww r
❑ I, 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.
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) �. .r
Grading
❑ I am exempt under Sec. B.•& P.C. for this reason
Driveway Enc.
Date Owner Infrastructure
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.
TOTAL ,
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100) valuation
or less.)
I certify that in the performance of lhp work for which this permit is issued, I shall not
employ any person in any manner so as to become•subject to the Workers' Compensation
Laws of California.
Date Owner
NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become
subject to the Workers' Compensation provisions 'of the Labor Code, you must' forthwith
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY'.1 1
I hereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, Civil Code.) -
Lender's Narrre -
Lender's Address
'This isa building permit when.properly filled out, signed and validated, and is subject to
expiration it work thereunder is suspended for 180 days.
I certify that I have read this application and state that the above information is correct.
I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives of this city to enter the above-
mentioned property for inspection purposes.
Signature of applicant Date
Mailing Address
City, State, Zip
HARD COPY
,��rvir�nnJ '
tf .1lutI mt. 1 e'1", ."1
ZONE:
BY:
Minimum Setback
Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE
INSPECTOR
Issued by:
Date's/±5 8$Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBIN94EES
IST FL. SQ. FT. ® $
2ND FL. SQ. FT. p
POR. SO. FT. ®
GAR. SQ. FT. ®
CARP. SO. FT.
WALL SQ. FT. ®
SQ. 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 �/(�, y „ / e�
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APP./EQUIP.
LAUNDRYTRAY
AIR HANDLING UNIT CFM
TEMP. POLE
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.
SO. FT. ®c
BATH TUB
SO. FT: ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
r
SQ.FT.GAR ® 3/ac
HOUSE SEWER
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 �/(�, y „ / e�
SEWER OR "SEPTIC TANK
ROUGH WIRING b '
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP./EQUIP.
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/Q
FINAL INSP.
ROOFINGREMARKS:
r
VENTILATION
FIRE ZONE ROOFING:
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL 3
LATHING S 3 O U
MESH
INSULATIONISOUND ' j
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL
DESERT SANDS UNIFIED SCHOOL DISTRICT
82-879 Highway 111
Indio, CA 92201
CERT IF`I'C�A�E7UF:,SCH000L"_,�F,gCILITY FEE WAIVER
TO: �I "j�/ �F L) 1, DATE:
This is to certify that PhL— �{-143✓
developer of IL -L— SALA '
located at
this school distric , is not required o pa
pursuant to the authority generated by Gove
Building permits for the project indicate
jurisdiction.
DE
which is
within
school facility fees
ment Code Section 53080.
ove may now be issued by your
SA. S IFIED SCHOOL DISTRICT
White -Building Department Yellow -Facilities Planning Pink -Developer (10)-38