05163 (SFD)P.O. BOX 1504
Building 78-105 CALLE ESTADO
Addressr44-1 0 CAllao Circle - LA QUINTA, CALIFORNIA 92253
Owner
Mailing `
Address 43-815 Washington St '
City! Zip Tel. -
Palm Desert .226, 1 345--7541
Contractor
Address
State Lic.
& Classif. 494889
Arch., Engr.,
Designer
Address
•1.
No. 05163
BUILDING: TYPE CONST. OCC: GRP.-
A.P. Number Cactus Plover
Legal Description
Project Description Plan Ir.R.: tot 127
Tela
City
Lic. # _ , Sq.. Ft. 1336 No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Tel.
City(Zip ( 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 is in full force and
effect
5
SIGNATURE DATE
OWNER -BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractors License Law for the following
reason: (Sec. 7031.5,ausiness 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 civil penalty of not more than two hundred dors ($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, Buisness and
Professions Code: The Contractors License Law does not appy to an owner of property who
buddss-or 'reproves thereon and who does such work himself or through his own employees,
provided that such improvements are not intended or offered for sale. If, however, the building
or rmprovernent is said within one year of completion, the owner-buider 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 bulds or improves thereon, and who contracts for
such protects wfth a contractor(s) licensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec B. & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
I 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.)
Policy 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.)
I certify that in the performance of the. work for which this permit is issued, I shall not
employ any penton in any manner so as to become subject to the Workers' Compensation
Laws of California.
Date Owner
NOTICE TO APPLICANT ff, after making this Certificate of Exemption you 'should become
subtect 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, CIO Code.)
Lenders Name
Lenders Address
This is a building permit when property filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days.
I certity 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
3timated Valuation
$73,279
Minimum Setback Distances:
- PERMIT
Front Setback from Center Line
AMOUNT
Plan Chk. Dep.
Side Street Setback from Center Line
Plan Chk. Bal.
Side Setback from Property Line
Q $t QA
Const.
INSPECTOR
{t
Mech.
Validated by:
33. nA
Electrical
Validation:
iy t
Plumbing
A9 nn
S.M.I.
Grading
Driveway Enc.
Infrastructure
1 6A
TOTAL
REMARKS
1Cy IL, E 1 fi3ittt.
i G`i {i cfs J�
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:
Dates 2 /28 % 8 FPermit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SQ. FT. ® $
UNITS
B GRADE Z�`S
:4,n'ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL SQ. FT. @
FORMS
SEWER OR SEF IC TAN
ROUGH WIRING.
MOBILEHOME SVC.
BAR SINK
POR. SQ, FT. ®
(ROUGH)
METER LOOP
GAR. SO, FT. ®
POWER OUTLET
ROOF DRAINS
GAS (FINAL)Z/,,
TEMP. POLE
DRAINAGE PIPING
CAR P. I SQ. FT. ®
GROUT
WATER HEATER
WALL SQ. FT.
FINAL INSP.
DRINKING FOUNTAIN.
FT ®
WATER SYSTEM
URINAL
ESTIMATED CONSTRUCTION VALUATION $
-$
WATER PIPING
NOTE: Not to be used as property tax valuation
F MING
FLOOR DRAIN
MECHANICAL FEES
O T
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
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.
SO. FT. ®c
1BATH TUB
SQ. FT. ®c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
INSULATIONISOUND
SQ.FT.GAR ® 3/ac
HOUSE SEWER
FINISH GRADING
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
LIND PLUMBINC;�
UNDERGROUND
A.C. UNIT
COLL. AREA
B GRADE Z�`S
:4,n'ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEF IC TAN
ROUGH WIRING.
DUCT WORK
ROCK STORAGE
REINF. 1GAS
(ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
GAS (FINAL)Z/,,
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
CU. yd.
$ plus x$
-$
LUMBER GR.
FINAL INSP
F MING
INAL INSP.
ROO ING5
O T
—�
7
REMARKS:
VENTILATION
FIRE ZONE ROOFING:
FIREPLACE
'
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION -
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATUREWINITIALS
GARDEN WALL FINAL