14546 (SFD)4
P.O. BOX 1504
Building78-495 CALLE TAMPICO
Address 48-627* Paseo Tarazo LA OUINTA, CALIFORNIA 92253
Owner
Roger Saailenberger & Associates
Mailin
Address 41 -865 -Boardwalk 42112
.CityZip ITel-
Palm
Desert., . 9i13 1619)777-7766
Contractor
Sating
Address
City
State Lia City
& Classif. B 4$$2.34-I-Lic. # 18.rf8
Arch., Engr.,
Designer Carlos •E aas — 'Engineer
jftlk� ChaAkleswortb Dr. (619) (619)328-7271
City Zip State
.. Cathedra -City CA 92234 Lic. # '
LICENSED CONTRACTOWS.DECLARATION '
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of the Business anndrofe�ssiior,nn ode, �7,S�d my license is in ulI f�ice
effect: �fP+,re��'% fiJCrC �.,4C. SCS'
SIGNATURE t DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractors License Law for the following
reason:., (Sec. 7031.5,Business and Professions Code: Any city or county which requires a
permit to construct, after, improve, .demoltsh, 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
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 rive hundred dollars ($500). -
❑ I, 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, 8uisness 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.oftered for sale. 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 knprove for the purpose of sale.)
O I, as owner of the property, am exclusively contracting with licensed contractors to corn
%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 contractors) ficensed pursuant to the Contractor's License Law.)
O 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 Corlylpensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.).
Policy No' Company
L3; -opy is filed with the city,... ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed N the permit is for one hundred dollars ($100) valuation
or less.)
I certify that In the performance of the 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-
bate'
aliforniaDale - Owner
NOTICE TO APPLICANT: ll, after making' this Certificate of Exemption you should become
subject to the Workers' Compensation provisions or. the Labor. Code, you must• forthwith
comply with such provisions or this permit shall be deemed revoked. -
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND
SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE
HUNDRED, THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION,
DAMAGES AS PROVIDED FORAN. SECTION 3706 OF THE LABOR CODE, INTEREST,' AND
ATTORNEY'S FEES.
This is a building permit when property 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.correcl.
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
No. 14546 ..
BUILDING: TYPE CONST:, OCC: GRP.•
A.P. Number 6b--Q82�34
Legal Description Lot 40 Tract. 20052•-4
Project Description SPD '. ��'
Laguna De. ` a Paz
ZONE: BY: '
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Cente Line
Side 'Setback from Properttri e�
i
FINAL DATE INSPECT
,i �
Issued by: Date s-��rmitN/ N
y-�
Validated by: �\ l
Validation: �\ J'9Q /, 1
Sq. Ft. 1950 No.
Size Stories
No. Dw.
Units.
New ❑ - Add ❑ Alter ❑
Repair ❑ . Demolition
Estimated Valuation $111,3924'00
PERMIT
AMOUNT
Plan Chk.rDepa,'
{
Plan -Chk. Bal. '
575.52 "
Const.
681.50.
Mech.
62.00
Electrical
1411-95
Plumbing,
'150.00.-
150..00.;.S.M.I.
S.M.I.
11, 20 ..
Grading
23 00
Driveway Enc.
.00
Infrastructure
2.482.99.
Arts -in Public Places
28.48
TOTAL
REMARKS
ZONE: BY: '
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Cente Line
Side 'Setback from Properttri e�
i
FINAL DATE INSPECT
,i �
Issued by: Date s-��rmitN/ N
y-�
Validated by: �\ l
Validation: �\ J'9Q /, 1
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SQ. FT. ® $
2ND FL. SO. FT. ®
POR. SO. FT. ®
GAR. SO. FT. ®
CAR P. SQ. FT.
WALL SO. FT. ®
SO. 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
V
FLOOR DRAIN
MECHANICAL FEES
HEATING (ROUGH)
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
DUCT WORK
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
HEATING (FINAL)
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
SERVICE
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® I1/. c
SEWAGE DISPOSAL
FINAL INSP.11 .9
SO.FT.GAR ® 3/ac
HOUSE SEWER
LUMBER GR.
FRAMING
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 A ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
GROUND PLUMBI
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
V
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP./EQUIP.
REINF. STEEL
GAS (FINAL)
I
{
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
FINAL INSP.
FINAL INSP.11 .9
GRADING
cu. yd.
$ plus x$
_$
LUMBER GR.
FRAMING
ROOFING 1A
�/J
Aa
moi/
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LA ING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIONATURESJINITIALS
GARDEN WALL FINAL